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Medicare Supplement
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  - Out-of-Pocket Costs
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Your Out-of-Pocket Costs with Medicare

Part A: Inpatient Hospital

Feature	Medicare Pays*	You Pay*
Deductible	Nothing	$1,100
First 60 Days	100%	$0
Coinsurance 61-90 days	All but $275 a day	$275 a day
Coinsurance 91-150 days	All but $550 a day	$550 a day
Coinsurance 151+ days	Nothing	Eligible Expenses
Blood	All but three pints
Skilled Nursing Facility Care First 20 Days	100%
Coinsurance 21-100 days	All but $137.50 a day	$137.50 a day
101^st day and after	Nothing	All

Part B: Supplemental Medical Coverage

Feature	Medicare Pays*	You Pay*
Deductible	Nothing	$155
Coinsurance	Generally 80% of Medicare approved expenses	Generally 20% of Medicare approved expenses
Excess Benefits	Nothing
Blood	All but three pints

Additional Benefits

Emergency Care Received Outside the U.S.	Nothing
At-home Recovery Visits	Nothing

*Reflects 2010 Medicare program

Medicare supplement insurance is underwritten by United World Life Insurance Company, Mutual of Omaha Plaza, Omaha, NE 68175. United World Life Insurance Company is licensed nationwide except in CT and NY. Neither United World Life Insurance Company nor its Medicare supplement insurance policies are connected with or endorsed by the U.S. government or the federal Medicare program. Policy forms WM1, WM2, WM3, WM4, WM8, WM12 or state equivalent (in ID, WM1-20859, WM2-20860, WM3-20861, WM4-20862; in OK, WM1-20731, WM2-20732, WM3-20733, WM4-20734). This policy has exclusions, limitations and reductions. Coverage may vary by state. An outline of coverage is available upon request. For cost and complete details of coverage, contact a local United World insurance agent or office. Each underwriting company is solely responsible for its contractual obligations. In NC, premiums are based on attained age, which means they will increase each year.

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