MEDICARE SUPPLEMENT PLAN COMPARISON
THIS CHART COMPARES KEY FEATURES OF THE AVAILABLE MEDICAL PLANS
PLAN FEATURES
United American
GOLD PLAN
AMOUNT YOU PAY
United American
PLATINUM PLAN
AMOUNT YOU PAY
ANNUAL DEDUCTIBLE $0 for Part A Hospital
$183* Part B Deductible
$0 for Part A Hospital
$183* Part B Deductible
COINSURANCE AMOUNT 20% for Part B Services Only $0
COINSURANCE MAXIMUM
OUT-OF-POCKET AMOUNT (OOP)
$1,000 - Incl.
Part B Deductible $183* Part B Deductible
LIFETIME MAXIMUM BENEFIT Unlimited Unlimited
NETWORK REQUIREMENTS Any Medicare Provider Any Medicare Provider
PART A HOSPITAL SERVICES $0 $0
PART B MEDICAL SERVICES 20% up to $1,000 max, then
$0 $0
PHYSICIAN OR URGENT CARE
OFFICE COPAY $20 $0
EMERGENCY ROOM COPAY $50 (waived if admitted) $0
PREVENTIVE/WELLNESS SERVICES $0 for Medicare Approved
Benefits
$0 for Medicare Approved
Benefits
*Please note that $183 is the 2018 Medicare Part B Deductible amount.
Your plan will automatically adjust each year to the Medicare Part B Deductible Amount.
This is only a summary. In case of errors or differences, please reference the official plan documents.
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