Services |
|
Medicare Pays |
|
Plan Pays |
|
You Pay |
|
Part A deductible |
|
$0 |
|
$0 |
|
$1632 |
|
First 60 days |
|
All but $1408(Part
A deductible) |
|
$0 |
|
$1632 (Part A deductible) |
|
61st through 90th day
|
|
All but $352 a day
|
|
$408 a day |
|
$0 |
|
|
|
|
|
|
|
|
|
91st day and after:
While
using 60 lifetime reserve days |
|
All but $704 a day
|
|
$816 a day |
|
$0 |
|
Once lifetime reserve days are used:
Additional 365 days |
|
$0 |
|
Balance of Medicare eligible expenses. |
|
$0 |
|
Beyond the additional 365 days |
|
$0 |
|
$0 |
|
All costs |
|
|
|
|
|
|
|
|
|
SKILLED NURSING FACILITY CARE
You must meet Medicare's requirements, including having been in a
hospital for at least 3 days and entered a Medicare approved facility
within 30 days after leaving the hospital. |
|
|
|
|
|
First 20 days |
|
All approved amounts |
|
All costs |
|
$0 |
|
21st
through 100th day |
|
All but $176.00 a day |
|
$0 |
|
Up to $176.00 a day |
 |
101st day and after |
|
$0 |
|
$0 |
|
All costs |
|
BLOOD |
|
|
|
|
|
|
|
First 3 pints |
|
$0 |
|
All costs |
|
$0 |
|
Additional amounts |
|
100% |
|
$0 |
|
$0 |
|
HOSPICE CARE |
|
All but very limited coinsurance for outpatient drugs
and inpatient respite care |
|
$0 |
|
A coinsurance or copayment, up to $5 for inpatient drugs and 5% of the Medicare-approved amount for inpatient respite care. |
|
|
|
|
|
|
|
|
|
MEDICARE (PART B)
Medical services
per calendar year. |
|
|
|
|
|
MEDICAL
EXPENSES In or out of the hospital, outpatient hospital treatment -
such as physician's services, inpatient and outpatient medical and
surgical services and supplies, physical and speech therapy, diagnostic
tests, durable medical equipment. |
|
|
|
|
|
Services |
|
Medicare Pays |
|
Plan Pays |
|
You Pay |
|
Part B deductible |
|
$0 |
|
$0 |
|
$240 (Part B deductible) |
|
Remainder of Medicare
approved amounts |
|
80% |
|
Coinsurance amount of Medicare eligible expenses. |
|
$0 |
|
Part B excess charges
(above Medicare approved amounts) |
|
$0 |
|
$0 |
|
All costs |
|
BLOOD |
|
|
|
|
|
|
|
First 3 pints |
|
$0 |
|
All costs |
|
$0 |
|
Next
$185 of Medicare approved amounts |
|
$0 |
|
$0 |
|
$240 (Part B deductible) |
|
Remainder of Medicare approved amounts |
|
80% |
|
Coinsurance amount of Medicare eligible expenses. |
|
$0 |
|
DURABLE MEDICAL EQUIPMENT |
|
|
|
|
|
First $185 of Medicare approved amounts |
|
$0 |
|
$0 |
|
$240 (Part B deductible) |
|
Remainder of Medicare approved amounts |
|
80% |
|
Coinsurance amount of Medicare eligible expenses. |
|
$0 |
|
Foreign Travel Emergency |
|
|
|
|
|
First $250 each calendar year |
|
$0 |
|
$0 |
|
All costs |
|
Remainder of Charges |
|
$0 |
|
$0 |
|
All costs |
|
|
|
|
|
|
|
|
|
At Home Recovery |
|
All approved amounts |
|
$0 |
|
$0 |
|
Preventive Care |
|
80% |
|
Coinsurance amount of Medicare eligible expenses |
|
$0 |
|
Preventive Care not covered by
Medicare |
|
$0 |
|
$0 |
|
All costs |
|
Other |
|
|
|
|
|
|
|
Deductible |
|
-------- |
|
-------- |
|
n/a |
|
Network |
|
-------- |
|
-------- |
|
No network limits |
|
Maximum Yearly Copayment |
|
-------- |
|
-------- |
|
n/a |
|
|
|
|
|
|
|
|
|
Brochure/Physician Directory |
|
|
|
 |
|
 |
|
|
|
|
|
|
|
|
|
Plan Specific
Information |
|
|
|
|
|
Informational Links |
|
Medicare Basics Medicare Part A
Medicare Part B Medicare And You 2018 |
|
|
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|