Medicare Supplement Coverage - Standard Benefits and Monthly Premium Rates - Plans A, F, F Plus, N, N Plus, G, G Plus

Oct 13, 2026

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Blue Cross and Blue Shield of Illinois outlines Medicare Supplement coverage with a comparison chart for standard benefits across plans A, B, D, G (and G Plus), K (and L), M, N (and N Plus), plus Medicare Select for G Select and G Select Plus. The document specifies plan availability rules, clarifies cost-sharing payments using a ✔ notation, and notes special limitations for applicants first eligible for Medicare before 2020. It also provides monthly premium rates effective April 1, 2024 for Illinois residents by age and tobacco status, including coverage details and footnotes on deductibles, out-of-pocket limits, and Medicare Select hospital network requirements.

LanguageEnglish

CategoryInvoices

FormatPDF

Pages43

Reading Time15 min

AccessFree to download

Standard Medicare Supplement Coverage

Plan availability and coverage notes

Benefit comparison chart (Plans A, F, F Plus, N, N Plus, G, G Plus)

Monthly Premium Rates

Rates effective April 1, 2024

Age and tobacco/non-tobacco pricing

Underwritten by HCSC Insurance Services Company Outline of Medicare Supplement Coverage—Standard Benefits for Plans A, F, F Plus, N, and N Plus; Standard and Medicare Select Benefits4 for Plan G and Plan G Plus This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan “A” available. Some plans may not be available. Only applicants first eligible for Medicare before 2020 may purchase Plans C, F, and High Deductible F. Blue Cross and Blue Shield of Illinois does not offer those plans shaded in gray below. Note: A ✔ means 100% of the benefit is paid | Benefits | Plans Available to All Applicants | | | | | | | | | Medicare first eligible before 2020 only | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | | A | B | D | G 1 | K 2 | L 2 | M | N | | C | F 1 | | Medicare Part Acoinsurance and hospital coverage (up to an additional 365 days after Medicare benefits are used up) | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | | ✔ | ✔ | | Medicare Part Bcoinsurance or
copayment | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | copays
apply 3 | | ✔ | ✔ | | Blood
(first three pints) | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔ | | ✔ | ✔ | | Part A hospice care coinsurance or
copayment | ✔ | ✔ | ✔ | ✔ | 50% | 75% | ✔ | ✔ | | ✔ | ✔ | | Skilled nursing facility coinsurance | | | ✔ | ✔ | 50% | 75% | ✔ | ✔ | | ✔ | ✔ | | Medicare Part A deductible | | ✔ | ✔ | ✔ | 50% | 75% | 50% | ✔ | | ✔ | ✔ | | Medicare Part B deductible | | | | | | | | | | ✔ | ✔ | | Medicare Part B excess charges | | | | ✔ | | | | | | | ✔ | | Foreign travel emergency (up to plan limits) | | | ✔ | ✔ | | | ✔ | ✔ | | ✔ | ✔ | | Out-of-pocket limit in 20252 | | | | | $7,2202 | $3,6102 | | | | | | Blue Cross and Blue Shield of Illinois, which refers to HCSC Insurance Services Company (HISC), an Independent Licensee of the Blue Cross and Blue Shield Association UWMETROOC-REV 092023 1 243706.1124 IL 1 Plans F and G also have a high deductible option which require first paying a plan deductible of $2,870 before the plan begins to pay. Once the plan deductible is met, the plan pays 100% of covered services for the rest of the calendar year. High deductible plan G does not cover the Medicare Part B deductible. However, high deductible plans F and G count your payment of the Medicare Part B deductible toward meeting the plan deductible. NOTE: HISC currently does not offer these high deductible options. 2 Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limit. 3 Plan N pays 100% of the Part B coinsurance, except for a co-payment of up to $20 for some office visits and up toa $50 co-payment for emergency room visits that do not result in an inpatient admission. 4 Medicare Select Plans require that you use Blue Cross and Blue Shield of Illinois contracting Medicare Select hospitals for non-emergency admissions to receive coverage for the Medicare Part A deductible. In an emergency, the $1,676 deductible is covered at any hospital from which you receive care. Only certain hospitals are network providers under this policy. Check with your physician to determine if he or she has admitting privileges at the network hospital. If he or she does not, you may be required to use another physician at time of hospitalization or you will be required to pay for all expenses. If you move out of the service area or out of state for this Medicare Select Plan, there will be a reduction of benefit coverage and you will have the opportunity to purchase any Medicare Supplement policy with comparable or lesser benefits offered by the insurer, or Medicare Supplement/ Select plans A, B, C, D, F, G, K, or L from any insurer within 63 days of termination. (Note: Plans C and F are no longer available to people new to Medicare on or after January 1, 2020. However, if you were eligible for Medicare before January 1, 202

FAQs

What does the ✔ symbol indicate in the benefits chart?

A ✔ means 100% of the benefit is paid.

Which Medicare supplement plans are available only to people first eligible for Medicare before 2020?

Plans C, F, and High Deductible F are only available to applicants first eligible for Medicare before 2020.

What are the monthly premium rates based on for Illinois residents?

Rates are effective April 1, 2024 and shown by age and tobacco vs. non-tobacco status for residents in specified Illinois counties.

Oct 13, 2026

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