Medicare Supplement Insurance — California
Medicare Supplement Insurance is currently available through State Farm Mutual Automobile Insurance Company. Details about coverages and benefits are listed below. Please read a brief description of the Medicare Supplement Insurance plans State Farm® offers in California.
State Farm Medicare Supplement Insurance is designed to help cover the deductibles, coinsurance and copayment amounts not covered by Medicare. Once you have a Medicare Supplement plan, both your plan and Medicare will help pay your covered medical expenses, lowering your out-of-pocket costs and giving you the confidence that your health insurance needs are met. And at State Farm we give you the flexibility to choose between different plans to meet your individual needs and budget.
| Benefits | Plan A | Plan D | Plan N | Plan G | Plan C | Plan F |
|---|---|---|---|---|---|---|
| Medicare Part A coinsurance and hospital coverage (up to an additional 365 days after Medicare benefits are used up) | ||||||
| Medicare Part B coinsurance or copayment | ||||||
| Blood (first 3 pints) | ||||||
| Part A hospice care coinsurance or copayment | ||||||
| Medicare Part A deductible | ||||||
| Skilled nursing facility care coinsurance (for days 21-100) | ||||||
| Foreign travel emergency (up to plan limits) | ||||||
| Medicare Part B excess charges | ||||||
| Medicare Part B deductible |
1 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.
If you require assistance in any language listed below, you have the right to free language assistance services. Please call the Health Response Center at 1-866-855-1212 for assistance.
The purpose of this notice is to inform you of the availability of language assistance services and how to file a complaint with State Farm®, the California Department of Insurance, and the U.S. Department of Health and Human Services Office of Civil Rights.
State Farm offers language assistance services in the top fifteen languages spoken in the state of California for certain transactions. State Farm also offers free Braille and large print for the visually impaired. For hearing or speech issues, the free nationwide telecommunications relay service (TRS) is available. To utilize this service, call 7-1-1.
State Farm does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age or disability.
To file a complaint with State Farm, please contact your State Farm Agent or use one of the following methods:
- Electronically: Visit www.statefarm.com/customer-care/contact-us and submit a General Inquiries comment
- Mail:
State Farm Insurance
ATTN: Michael Tipsord
One State Farm Plaza
Bloomington, IL 61710 - Telephone: 800-STATE-FARM (800-782-8332)
Your complaint will be handled by a State Farm Specialist.
To file a complaint with the California Department of Insurance, use one of the following methods:
- Electronically: Go to www.insurance.ca.gov and submit a complaint electronically by clicking on File a Complaint
- Mail:
California Department of Insurance
Consumer Services Division
300 S Spring Street, South Tower
Los Angeles, CA 90013 - Telephone: 1-800-927-4357
If there is concern of discrimination based on race, color, national origin, age, disability, or sex you may file a complaint with the U.S. Department of Health and Human Services Office of Civil Rights. To file a complaint, use one of the following methods:
- Electronically: Go to https://ocrportal.hhs.gov/ocr/cp/complaint_frontpage.jsf to submit a complaint electronically
- Telephone: 1-800-368-1019
If you need any assistance or have any questions, please contact your State Farm agent or the Health Response Center at 1-866-855-1212. Thank you for choosing State Farm for your health insurance needs.
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Disclosures
AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST.
This is a marketing tool intended for use in the sale of insurance. Completion of an application for a State Farm insurance policy will require contact with a State Farm agent/licensed insurance producer.
In some states coverage is available if you are under age 65 and are Medicare eligible due to disability and/or End Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). These policies are not connected with or endorsed by the U.S. Government or the Federal Medicare program. This information is only a general description of coverage. A complete statement of coverage is found only in the policy. Renewal premiums may increase periodically depending on your age at the time the policy was issued. Policy coverage's, exclusions and limitations may vary in some states. For exact terms and conditions see: Medicare Supplement Insurance Policy series Policy series 97037HCA, 97038HCA, 97039HCA, 97067CA, 97068CA, and 97069CA. For additional details on coverage and cost, contact a State Farm agent/licensed insurance producer.
State Farm Mutual Automobile Insurance Company
Bloomington, IL
MSI-CA.7