Plan Highlights

The LRFA Medicare Supplemental Plan saves you money!

Medicare is an essential means of protection for millions of Americans 65 and older. But Medicare doesn’t cover everything. A “Medigap” plan is health insurance sold by private insurance companies to fill gaps in Medicare coverage (coinsurance, copayments, or deductibles). The LRFA Medicare Supplemental plans are designed to help our members cover those expenses.  There are different LRFA Medicare Supplemental plans, designed to meet your needs, including a separate Prescription Drug coverage plan (M-3). Join LRFA and let us help you.

Great customer service!

“I always found the people I spoke with when calling exceedingly helpful and pleasant.“

“I have been very happy with LRFA for many years.“

The LRFA Medicare Supplemental Plan is unique.

LRFA strives to help make life a little easier for our members. We offer these benefits only to members with Medicare coverage. LRFA rates are the same for all 50 states. For insurance companies, your plan rates vary by state, gender, and other factors.

LRFA makes every effort to set our benefit plans at affordable rates for our members. Monthly payments are uniform, regardless of a participant’s state of residence or gender. Choice of health care providers is left entirely up to our member. When shopping a plan, service and reliability are also important factors to consider. LRFA takes pride in giving our members the best service possible. Our Medicare Supplemental department has been working to serve our members’ since 1966.

Features

  • Simple application with basic health questions; no physical exam required
  • Enroll at any time, no need to wait for an “enrollment period”
  • Premiums do not vary by state of residence
  • Coverage when traveling, without pre-authorization
  • Change or increase plans at any time, without a penalty
  • Full choice of doctors, hospitals, and pharmacies. No networks.
  • All prescription drugs (from high cost, rare, to the least expensive generic drugs) are covered in M3
  • Excellent customer service! – 97% of members surveyed rated our customer service as good or excellent!

Eligibility & Enrollment

Download a Medicare Supplemental Plan enrollment form

Current LRFA members must sign and complete the enrollment form, which includes basic health questions, and submit it by mail, along with all applicable fees. Upon receipt, LRFA will review your application and notify you of acceptance and start date. Anyone not currently an LRFA member may apply for membership at the same time as application. LRFA is not an insurance company and our plans are available only to LRFA members.*

Enrollment is open to all LRFA members, age 65 and older, who have Medicare coverage (Part A & B). You must provide a copy of your valid Medicare card. Individuals on Medicaid, Disability, or other government medical assistance programs are not eligible. Individuals with Medicare Advantage plans are not eligible.

What Is Covered?

The LRFA Medicare Supplemental Plans are designed with simplicity and cost-effectiveness. They help cover physician and hospital services, out-patient care, skilled nursing facility services, diagnostic tests, radiology and laboratory charges. We process your Medicare statements and follow Medicare guidelines for approved services, using the calculated amounts the patient is expected to pay. Invoices you receive from the provider should be submitted for all claims.

M-Basic covers:

  • Medicare Part A hospital co-insurance and Medicare Part B medical co-insurance
  • Medicare Part A and B blood coverage
  • After a $8,000 benefit allowance is reached, expenses are covered at a 50% rate.

M-1 covers:

  • Medicare Part A hospital deductible AND co-insurance
  • Medicare Part B medical deductible AND co-insurance
  • Medicare Part A and B blood coverage
  • Skilled nursing facility coinsurance
  • After a $8,000 benefit allowance is reached, expenses are covered at a 50% rate.

M-2 covers excess charges:

  • 100% of the difference between Medicare’s approved amount for Part B services and the billed provider charges
  • maximum benefit for a single service rendered by a provider is $500
  • maximum benefit allowed in a calendar year is $4,000

M-3 is a Prescription drug coverage for LRFA members ages 65 and over. This plan covers 50% of all prescription drugs with no coverage gaps after a deductible has been met, up to the annual maximum. Drugs must be prescribed by a licensed physician but do not have to be Medicare approved. Participation in Medicare is not required.

M-4 covers:

  • Everything included in M-Basic, M-1, M-2, and M-3
  • PLUS: Preventive care, including check-ups, cholesterol screenings, diabetes screenings, hearing tests and thyroid testing not covered by Medicare
  • Short-term care, including at-home medical assistance while recovering from an illness, injury or surgery, if already receiving Medicare covered home health care services
  • After a $8,000 benefit allowance is reached, expenses are covered at a 50% rate.

M-6 covers:

  • same as M-1, at a 50% rate
  • The maximum benefit allowed is $12,000 per calendar year

M-7 covers:

  • covers the same as M-4, after a deductible has been met
  • After a $8,000 benefit allowance is reached, expenses are covered at a 50% rate.

Waiting Periods

Waiting periods for benefit claims are 3 months (from the date of acceptance into a plan), for all new participants.

Not Covered

The LRFA Medicare Supplemental Plans DO NOT cover:

  • Routine vision and dental care
  • Over-the-counter purchased drugs or supplies, including hearing aids
  • Services or supplies not approved or not within Medicare guidelines
  • Expenses covered under another insurance plan or government medical assistance program, that is primary to Medicare
  • Expenses not in accordance with Medicare and LRFA regulations or existing laws.
  • Limitations may apply for expenses in excess of usual and customary charges.

Plan Fees for 2027

M-Basic COVERS:

  • Part A hospital co-insurance; Part B medical co-insurance
  • Part A and B blood coverage
  • after a benefit of $8,000 is reached, benefits are covered at 50%
 Age 65-70: $139
Age 71-80: $199
Age 81+: $208
per month
M-1 COVERS:

  • 100% Part A deductible, hospital co-insurance amounts, skilled nursing facility co-insurance amounts
  • 100% Part B deductible, Part B co-insurance amounts
  • 100% first 3 pints of unreplaced blood
  • after a benefit of $8,000 is reached, benefits are covered at 50%
 Age 65-70: $210
Age 71-80: $318
Age 81+: $330
per month
M-2 COVERS:

  • 100% of the difference between Medicare’s approved amount for Part B services and the actual billed provider charges
  • maximum benefit for a single service rendered by a provider is $500
  • maximum benefit allowed in a calendar year is $4,000
 Age 65-70: $60
Age 71-80: $88
Age 81+: $115
per month
M-3 COVERS:

  • 50% of prescription drug expenses after $500 deductible is met
  • maximum benefit allowed in a calendar year is $5,000.00
 Age 65-70: $100
Age 71-80: $139
Age 81+: $189
per month
M-4 Provides same coverage as plans M-1, M-2 and M-3 combined, plus:

  • “Preventive Medical Care”
  • doctor prescribed “At-Home Recovery Services”
  • after a benefit of $8,000 is reached, benefits are covered at 50%
 Age 65-70: $370
Age 71-80: $545
Age 81+: $564
per month
M-6 COVERS all procedures covered in M-1, at a 50% rate

  • maximum benefit allowed in a calendar year is $12,000
 Age 65-70: $98
Age 71-80: $139
Age 81+: $166
per month
M-7 COVERS all procedures covered in M-4, after a deductible of $2,500 is met

  • after a benefit of $8,000 is reached, benefits are covered at 50%

 

 Age 65-70: $220
Age 71-80: $242
Age 81+: $284
per month

Compare Medicare Supplemental Plans

Quick comparison charts Here is a quick look at how these plans compare in terms of coverage. Medicare alone does not offer complete protection from rising medical costs. For this reason most people seek additional coverage, which pays some of the amounts that Medicare does not pay for covered services and may pay for certain services not covered by Medicare. This type of private insurance is known as Medigap and is regulated by federal and state law, which mandates that all plans follow the same 10 standardized plans. This makes it easier for consumers to comparison shop.

Please read your plan regulations to determine how individual charges are calculated and any limits that may apply. LRFA is not an insurance company and provides benefits exclusively to our members.*

**Medigap plans C & F will no longer accept new enrollment as of Jan 1, 2020. If you live in Massachusetts, Minnesota, or Wisconsin, your state offers different standardized plans.

 *Important Disclosures

The LRFA Medicare Supplemental Plan is a member benefit provided by LRFA, a nonprofit organization. It is not underwritten by an insurance company, and benefits are paid by LRFA, not by an insurer. The plan is not covered by the Pennsylvania Life and Health Insurance Guaranty Association. The plan is not major medical coverage and does not meet the requirements of the Affordable Care Act. It is available only to LRFA members and eligible dependents. Benefits are subject to exclusions, reductions, limitations, and waiting periods, and benefit amounts and fees depend on the plan selected. Please review the brochure and plan Regulations for complete details.