Medicare Supplement Plan A

A Medicare Supplement plan, otherwise known as Medigap coverage, from South Dakota Farm Bureau Health Plans will help pay for many costs not covered by Medicare. Because people have different needs, circumstances, expectations and budgets, South Dakota Farm Bureau Health Plans offers four Medicare Supplement plans. Each plan has varying levels of supplemental coverage.

The charts below outline the coverage of Medicare Supplement Plan A, which offers basic benefits only. This plan is ideal for those who want coverage for many coinsurance payments, but do not foresee using a lot of health care services.

Guaranteed Renewable

As long as you make premium payments on time and do not file claims with false or misleading information you’ll have the security of South Dakota Farm Bureau Health Plans Medicare Supplement plan.

Money Back Guarantee

If you are not 100 percent satisfied with your South Dakota Farm Bureau Health Plans Medicare Supplement plan, return the Evidence of Coverage to us within 30 days after you receive it and we will gladly refund any payments you have made (less any benefits provided.)

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Plan A Details

Note: The benefits and costs shown are for plans effective on or after January 1, 2022.

Plan A covers these basic benefits:

Hospitalization

Part A coinsurance pays coverage for 365 additional days after Medicare benefits end

Medical Expenses

Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services

Blood

First three pints blood each year

Hospice

Part A coinsurance

HOSPITALIZATION*

Semiprivate room and board, general nursing and miscellaneous services and supplies
MEDICARE PAYS PLAN A PAYS YOU PAY
First 60 Days All but $1,484 $0 $1,484
+Part A deductible.
61st thru 90th day All but $371 a day $371 a day $0
91st day and after: -While using 60 lifetime reserve days All but $742 a day $742 a day $0
Once lifetime reserve days are used: -Additional 365 days $0 100% of Medicare eligible expenses $0**
-Beyond additional 365 days $0 $0 All costs

SKILLED NURSING FACILITY CARE

You must meet Medicare’s requirements, including having been in a hospital for at least 3 days and entered a Medicare approved facility within 30 days after leaving hospital
MEDICARE PAYS PLAN A PAYS YOU PAY
First 20 Days All approved amounts $0 $0
21st thru 100th day All but $185.50 a day $0 Up to $185.50 a day
101st day and after $0 $0 All costs

BLOOD

MEDICARE PAYS PLAN A PAYS YOU PAY
First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0

HOSPICE CARE

MEDICARE PAYS PLAN A PAYS YOU PAY
You must meet Medicare’s requirements, including a doctor’s certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0

* A benefit period  begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

** NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

MEDICAL EXPENSES

IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment

 

 MEDICARE PAYSPLAN A PAYSYOU PAY
First $203 of Medicare Approved Amounts*$0$0$203
Remainder of Medicare Approved AmountsGenerally 80%Generally 20%$0

 

PART B EXCESS CHARGES

 MEDICARE PAYSPLAN A PAYSYOU PAY
(ABOVE MEDICARE APPROVED AMOUNTS)$0$0All costs

 

BLOOD

 MEDICARE PAYSPLAN A PAYSYOU PAY
First 3 pints$0All costs$0
Next $203 of Medicare Approved Amounts*$0$0$203
Remainder of Medicare Approved Amounts80%20%$0

 

CLINICAL LABORATORY SERVICES

 MEDICARE PAYSPLAN A PAYSYOU PAY
Tests For Diagnostic Services100%$0$0

* Once you  have been billed $203 of Medicare approved amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

HOME HEALTHCARE

Medicare Approved Services  
MEDICARE PAYS PLAN A PAYS YOU PAY
Medically necessary skilled care services and medical supplies 100% $0 $0
Durable Medical Equipment $0 $0 $203
+Part B deductible.
Remainder of Medicare Approved Amounts 80% 20% $0

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