Senior Plus Plan Benefits
Senior Plus Plan
If you visit the doctor often or take daily prescription medications, the Senior Plus Plan may offer the best coverage for you because it provides coverage for Medicare Part B services (medical services and supplies) as well as Part A services (hospital stays). It also offers prescription drug copays for generic and brand name preferred and non-preferred medications.
The monthly rate is higher than for the Senior Plan, but this plan may help you better manage your overall out-of-pocket costs. One of the main differences between the Senior Plus and the Senior Plan is Part B coverage. On the Senior Plus Plan, all Medicare-eligible Part B expenses that are not paid by Medicare will be paid by your Senior Plus Plan after you pay the Medicare Part B deductible.
| Part A services (as defined by Medicare) |
Medicare pays |
Senior Plus Plan pays |
You pay1 |
|
Hospital stays:
Semi-private room and board, general nursing, and other hospital services and supplies |
- 100% days 1-60
- costs over $256 a day for days 61-90
- costs over $512 a day for days 91-150 (lifetime reserve days)
|
- $400 of the Part A deductible (for every benefit period)2
- $256/day for days 61-90
- $512/day for days 91-150 (lifetime reserve days); 100% after reserves are depleted
- All costs after 150 days
|
$624 (remainder of the Part A deductible)2 |
| Skilled nursing facility care |
- 100% days 1-20
- costs over $128 a day for days 21-100
|
Not a covered benefit |
- $128/day for days 21-100
- 100% after 100 days
|
| Part B services (as defined by Medicare) |
Medicare pays |
Senior Plus Plan pays |
You pay1 |
|
Medical services and supplies:
Doctors' services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment and other services. |
80% of Medicare-approved amounts for covered services |
Remaining 20% of Medicare-approved amounts |
- $135 (Part B deductible)3
|
| Diagnostic clinical laboratory service |
100% of Medicare-approved amounts for covered services |
Nothing (Medicare covers it at 100%) |
Costs above Medicare-approved amounts or not covered by Medicare |
| Retail prescription drugs |
| (Up to a 30-day supply) |
The lesser of drug cost or: |
| Generic |
Nothing |
Costs over copay amount |
$15 copay |
| Preferred |
Nothing |
Costs over copay amount |
$30 copay (if generic is unavailable)4 |
| Non-preferred |
Nothing |
Costs over copay amount |
$45 copay (if generic is unavailable)4 |
| Home delivery prescription drugs |
| (Up to a 90-day supply) |
The lesser of drug cost or: |
| Generic |
Nothing |
Costs over copay amount |
$30 copay |
| Preferred |
Nothing |
Costs over copay amount |
$75 copay (if generic is unavailable)4 |
| Non-preferred |
Nothing |
Costs over copay amount |
$115 copay (if generic is unavailable)4 |
| 1You are responsible for 100% of any charges not covered by Medicare or that are above the Medicare-approved amount.
2You must pay the Part A deductible for every benefit period, which begins when you are admitted and ends when you have not received hospital or skilled nursing facility treatment for 60 days in a row.
3You pay the Part B deductible once a year.
4The cost for a preferred or non-preferred drug can be higher than the copay amount listed if a preferred or non-preferred drug is purchased when a generic is available. You must pay the generic copayment and the difference in cost between the drug cost of the preferred/non-preferred drug and the drug cost of its generic equivalent. |
|
Retired |
Actively working* |
| Senior Plus Plan |
$270/month |
$310/month |
| *If you work more than 20 hours a week, you may be considered "actively working." Please contact GuideStone at 1-888-98-GUIDE (1-888-984-8433) for more rating information. |
|
|
Remember: The Senior Plus Plan pays health care costs based on Medicare-approved amounts. The participant pays all of the costs for services not covered by Medicare and costs above the Medicare-approved amount.
Since Group Plans employers choose which plans to offer their employees, this plan may not be available to you. See your employer’s authorized benefits representative for details.
If you’d like more assistance in choosing a plan or information about how our plans coordinate with Medicare, email us or you can reach a Customer Relations specialist toll-free at 1-888-98-GUIDE (1-888-984-8433).