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Loyal American Medicare Supplement Plan Information
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Loyal American Medicare Supplement Rates Rates effective January 1, 2011 Plan A Plan B Plan C Plan D Plan F Plan G Plan N Male/65yr Preferred (970-972) $88.75 $103.64 $123.96 $108.68 $128.52 $111.43 $89.94 Female/65yr Preferred (970-972) $77.26 $90.09 $107.81 $94.42 $111.75 $96.87 $78.20 Male/65yr Standard (970-972) $98.68 $115.14 $137.74 $120.65 $142.78 $131.45 $99.94 Female/65yr Standard (970-972) $85.76 $100.17 $119.86 $104.98 $124.11 $107.66 $86.84 Male/65yr Preferred (973-979) $83.53 $97.54 $116.67 $102.29 $120.96 $104.88 $84.90 Female/65yr Preferred (973-979) $72.71 $84.79 $101.47 $88.87 $105.18 $91.17 $73.60 Male/65yr Standard (973-979) $92.87 $108.36 $129.63 $113.55 $134.38 $116.52 $94.06 Female/65yr Standard (973-979) $80.72 $94.28 $112.81 $98.80 $116.81 $101.32 $81.75 Benefits Plan A Plan B Plan C Plan D Plan F Plan G Plan N Medicare Part A Coinsurance and Hospital Benefits Medicare Part A Deductible   Medicare Part B Coinsurance or Co-payment 2 Medicare Part B Deductible           Medicare Part B Excess Charges           Blood (First Three Pints) Hospice Care Coinsurance or Co-payment Skilled Nursing Coinsurance     Foreign Travel Emergency (Up to Plan Limits)3     Medicare Preventive Care Part B Coinsurance

1. Medigap Plan F offers a high deductible option. You must pay for Medicare-covered costs up to the high-deductible amount ($2,070 in 2012) before your Medigap policy pays anything
2. 100% part B coinsurance except up to $20 copayment for office visits and up to $50 copayment for ER.
3. You must also pay a separate deductible for foreign travel emergency ($250 per year).
4. After you meet your out-of-pocket yearly limit and your yearly Part B deductible ($140 in 2012) the plan pays 100% of covered services for the rest of the calendar year (This applies only to plans K & L)
5. Modified Plan F offers an individual assistance program, as well as coverage for preventive dental care (available in some states)

• 2012 Out of Pocket Limit for Plan K is $4,660.
• 2012 Out of Pocket Limit for Plan L is $2,330.