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ODS Health Plans - Senior Select Medicare Supplement Plan Information
Application (PDF) | Plan Brochure & Rate Sheet | Medicare and You | Choose Medigap
ODS Health Plans Medicare Supplement Rates Rates effective through 12/31/2012 Plan A Plan F High Ded. Plan F Plan N Ages 65-69* $108 $174 $40 $122 Ages 70-74 $124 $198 $45 $139 Age 75-79 $141 $227 $52 $159 Age 80+ $142 $228 $52 $160 Benefits Plan A Plan F High Ded. Plan F Plan N Medicare Part A Coinsurance and Hospital Benefits Medicare Part A Deductible   Medicare Part B Coinsurance or Co-payment 3 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 *The 65- to 69-year-old rate applies to persons on Medicare by reason of disability who are under age 65. Rates are for Automatic Funds Transfer (AFT). Paper billing is $5 per month extra.

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.