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Care Plus Medigap is the plan for government retirees subscribed to Parts A and B of Medicare. In addition, optional dependents of active government employees will be eligible for the supplemental coverage as long as they are not subscribed to Medicare on grounds of disability or End Stage Renal Disease (ESRD).
It is the name of our supplemental policy to Original Medicare which is offered to retired government employees with the Medicare Parts A and Part B and can help pay for some of the health care costs that Original Medicare does not cover, such as coinsurance and deductibles.
Triple-S Salud offers you the C and D models of Medicare supplemental plans. The coinsurance and deductibles covered by this policy will accrue according to the charges accepted under Original Medicare.
Model C is a plan that covers deductibles and coinsurance established for benefits covered in Part A and Part B Medicare Program. This model applies to affiliates who turn 65 years on or before December 31, 2019, be disabled or have Medicare before that date.
Model D is a plan that covers deductible established for Part A and coinsurance for benefits covered in the Medicare Part A and Part B. That means, it covers all Model C benefits, except the annual Medicare Part B. This applies to affiliates who turn 65 after December 31, 2019 or are disabled after that date.
The following table allows you to compare some of the benefits, deductibles, and coinsurance covered by Medicare and the Care Plus Medigap for Models C and D.
| BENEFITS | MEDICARE | CARE PLUS MODEL C1 | YOU | CARE PLUS MODEL D2 | YOU |
|---|---|---|---|---|---|
| Hospital Services | |||||
| Dedicible period of illness $1,484 | $0 | $1,484 | $0 | $1,484 | $0 |
| First 60 days | 100% | $0 | $0 | $0 | $0 |
| Days 61 to 90 | All, except $371 daily | $371 daily | $0 | $371 daily | $0 |
| While the 60 days of lifetime reserve are used | All, except $742 daily | $742 daily | $0 | $742 daily | $0 |
| Once the 365 additional days of lifetime reserve are used | $0 | 100% of the eligible expenses of Medicare | $0* | 100% of the eligible expenses of Medicare | $0* |
| SKILLED NURSING FACILITY | |||||
| First 20 days | 100% | $0 | $0 | $0 | $0 |
| Days 21 al 100 | All, except $185.50 daily | $185.50 daily | $0 | $185.50 daily | $0 |
| Day 101 and subsequent days | $0 | $0 | All expenses | $0 | All expenses |
|
MEDICAL SERVICES IN AND OUT OF THE HOSPITAL
Physician services, supplies and medical services for hospitalized and ambulatory patients, physical and speech therapy, diagnostic tests, durable medical equipment. |
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| Annual Deductible | $0 | $203 | $0 | $0 | $203 |
| Coinsurance | 80% | 20% | $0 | 20% | $0 |
| BLOOD | |||||
| First 3 pint | $0 | 100% | $0 | 100% | $0 |
* When your Part A Medicare hospital benefit has been exhausted, Triple-S Salud will pay any amount Medicare would have paid up to 365 additional days, as provided in the policy’s basic coverage. During this period the hospital cannot charge you for the balance based in any difference between the billed charges and the amount Medicare would have paid.
| Documents | Size | ||||||
|---|---|---|---|---|---|---|---|
Care Plus Medigap Summary of CoverageIn the Care Plus Medigap Summary, you will find detailed information about your costs and Medicare |
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Individual Pharmacy Plan Brochure and PolicyYou will find detailed information about your standalone Rx plan, copays and/or coinsurances applicable for the purchase of medically necessary drugs and included in your Prescription Drug list. This Standalone Rx plan is not a substitute for Medicare's Part D, nor does it substitute medication benefits covered under Medicare. It does not pay for Medicare's deductibles or coinsurances and it is not a substitute for any supplemental Medicare coverage. |
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