Medicare Supplement Plan N (Chicago Area)

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Plan N features a lower monthly premium and low copayments on commonly used services. You can view plan details below.

Click here to view 2011 Plan N (Chicago area) information.

Once you have been billed $140 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.

(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.)

The monthly premiums shown here are for Illinois residents living in Cook, DuPage, Kane, Lake, McHenry and Will counties.

Services/Benefits

	Plan N (Chicago Area)
Monthly Premium
Age 65	$135.02
Age 66	$141.77
Age 67	$148.85
Age 68	$156.30
Age 69	$164.11
Age 70	$172.32
Age 71	$180.93
Age 72	$189.98
Age 73	$199.48
Age 74	$209.45
Age 75	$219.93
Age 76	$230.92
Age 77	$242.47
Age 78	$254.59
Age 79	$263.47
Age 80	$270.84
Age 81	$278.86
Age 82	$287.63
Age 83	$291.66
Age 84	$296.08
Age 85+	$300.91

Medicare Part A Hospital Services Per Benefit Period

	Health Alliance Pays	Member Pays
Hospitalization* (Semi-private room and board, general nursing and miscellaneous services and supplies)
First 60 days	$1,156 (Part A deductible)	$0
61st thru 90th day	$289 a day	$0
91st day and after:
-While using 60 lifetime reserve days	$578 a day	$0
-Once lifetime reserve days are used, additional 365 days	100% of Medicare-eligible expenses	$0**
-Beyond additional 365 days	$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 having entered a Medicare-approved facility within 30 days of leaving the hospital)
First 20 days	$0	$0
21st thru 100th day	Up to $144.50 a day	$0
101st day and after	$0	All costs
Blood
First three pints	Three pints	$0
Additional amounts	$0	$0
Hospice Care (You must meet Medicare’s requirements, including a doctor’s certification of terminal illness)	Medicare copayment/coinsurance	$0
**NOTICE: When your Medicare Part A hospital benefits are exhausted, Health Alliance 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.

Medicare Part B Medical Services Per Calendar Year

	Health Alliance Pays	Member Pays
Medical Expenses In or Out of the Hospital and Outpatient Hospital Treatment (Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment)
First $140 of Medicare approved amounts*	$0	$140 (Part B deductible)
Remainder of Medicare approved amounts	Balance other than up to $20 per office visit and up to $50 per emergency room visit.	Up to $20 per office visit and up to $50 per emergency room visit.
Part B excess charges (above Medicare approved amounts)	$0	All costs.
Blood
First 3 pints	All costs	$0
Next $140 of Medicare approved amounts*	$0	$140 (Part B deductible)
Remainder of Medicare approved amounts	20%	$0
Clinical Laboratory Services, Tests for Diagnostic Services	$0	$0

Medicare Parts A & B Services

	Health Alliance Pays	Member Pays
Home Health Care, Medicare Approved Services
Medically necessary skilled care services and medical supplies	$0	$0
Durable medical equipment:
-First $140 of Medicare approved amounts*	$0	$140 (Part B deductible)
-Remainder of Medicare approved amounts	20%	$0

Other Benefits Not Covered by Medicare

	Health Alliance Pays	Member Pays
Foreign Travel-Not Covered by Medicare (Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA)
First $250 each calendar year	$0	$250
Remainder of charges	80% to a lifetime maximum benefit of $50,000	20% and amounts over the $50,000 lifetime maximum

Our Stand-Alone Drug Plan pairs well with any of our Medicare Supplement plans. Visit the PDP Benefits page for more information.

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