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United of Omaha Medicare Supplement Plan Information
Application (PDF) | Plan Description & Rate Sheet | Medicare and You | Choose Medigap
Medicare Supplement Plans & Rates Rates effective 1/1/2012 Plan A Plan F Plan G Plan M Male / 65yr / Non-tobacco / zip codes 970-972 $79.89 $115.79 $94.97 $90.44 Female / 65yr / Non-tobacco / zip codes 970-972 $75.89 $109.99 $90.21 $85.91 Male / 65yr / Tobacco / zip codes 970-972 $91.83 $133.09 $109.16 $113.95 Female / 65yr / Tobacco / zip codes 970-972 $87.23 $126.42 $103.69 $98.75 Male / 65yr / Non-tobacco / zip codes 973-979 $76.70 $111.16 $91.17 $86.82 Female / 65yr / Non-tobacco / zip codes 973-979 $72.86 $105.59 $86.60 $82.47 Male / 65yr / Tobacco / zip codes 973-979 $88.16 $127.76 $104.79 $99.79 Female / 65yr / Tobacco / zip codes 973-979 $83.74 $121.36 $99.54 $94.80 Benefits Plan A Plan F Plan G Plan M Medicare Part A Coinsurance and Hospital Benefits Medicare Part A Deductible   50% Medicare Part B Coinsurance or Co-payment 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 **** If you and the person you are living with on the same application, you are each eligible for a 7% discount from the normal rate/ If the person you are living with currently has a Mutual of Omaha plan, you are eligible for a 7% discount from the normal rate****

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.