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 G. This plan offers comprehensive coverage, including Medicare Part B excess charges. Plan G does not cover the Medicare Part B deductible.
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.
USA Senior Care Network Benefit
If a Medicare Supplement member requires an inpatient hospital stay involving a Part A deductible and uses a facility that is contracted, as part of The Accountable Alliance program with SDFB Health Plans they will receive a $100 credit to be applied to future premium payment(s). Click here to learn more.
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 G Details
Note: The benefits and costs shown are for plans effective on or after January 1, 2022.
Basic Benefits
Plan G covers these basic benefits:
HospitalizationPart A coinsurance pays coverage for 365 additional days after Medicare benefits end | Medical ExpensesPart B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services |
BloodFirst three pints blood each year | HospicePart A coinsurance |
2021 Medicare (Part A) – Hospital Services – Per Benefit Period
HOSPITALIZATION*
Semiprivate room and board, general nursing and miscellaneous services and supplies| MEDICARE PAYS | PLAN G PAYS | YOU PAY | |
|---|---|---|---|
| First 60 Days | All but $1,484 | $1,484
+Part A deductible. |
$0 |
| 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 G PAYS | YOU PAY | |
|---|---|---|---|
| First 20 Days | All approved amounts | $0 | $0 |
| 21st thru 100th day | All but $185.50 a day | Up to $185.50 a day | $0 |
| 101st day and after | $0 | $0 | All costs |
BLOOD
| MEDICARE PAYS | PLAN G PAYS | YOU PAY | |
|---|---|---|---|
| First 3 pints | $0 | 3 pints | $0 |
| Additional amounts | 100% | $0 | $0 |
HOSPICE CARE
| MEDICARE PAYS | PLAN G 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.
2021 Medicare (Part B) – Medical Services – Per Calendar Year
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 PAYS | PLAN G PAYS | YOU PAY | |
|---|---|---|---|
| First $203 of Medicare Approved Amounts* | $0 | $0 | $203 |
| Remainder of Medicare Approved Amounts | Generally 80% | Generally 20% | $0 |
PART B EXCESS CHARGES
| MEDICARE PAYS | PLAN G PAYS | YOU PAY | |
|---|---|---|---|
| (ABOVE MEDICARE APPROVED AMOUNTS) | $0 | 100% | All costs |
BLOOD
| MEDICARE PAYS | PLAN G PAYS | YOU PAY | |
|---|---|---|---|
| First 3 pints | $0 | All costs | $0 |
| Next $203 of Medicare Approved Amounts* | $0 | $0 | $203 |
| Remainder of Medicare Approved Amounts | 80% | 20% | $0 |
CLINICAL LABORATORY SERVICES
| MEDICARE PAYS | PLAN G PAYS | YOU PAY | |
|---|---|---|---|
| Tests For Diagnostic Services | 100% | $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.
2021 Parts A & B
HOME HEALTHCARE
Medicare Approved Services| MEDICARE PAYS | PLAN G 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 |
2021 Other Benefits - Not Covered by Medicare
Foreign Travel
NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during first 60 days of each trip outside U.S.
| MEDICARE PAYS | PLAN G PAYS | YOU PAY | |
|---|---|---|---|
| First $250 each calendar year | $0 | $0 | $250 |
| Remainder of charges | $0 | 80% to a lifetime maximum benefit of $50,000 | 20% and amounts over $50,000 lifetime maximum |
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