Medicare (Part A) Hospital Services - Per Benefit Period

HOSPITALIZATION*
Semiprivate room and board, general nursing and miscellaneous services and supplies
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First 60 days All but $1,316 $1,316 (Part A deductible) $0
61st through 90th day All but $329 a day $329 a day $0
91st day and after
(while using 60 lifetime reserve days)		 All but $658 a day $658 a day $0
91st day and after:
(once lifetime reserve days are used)
Additional 365 days		 $0 100% of Medicare Eligible Expenses $0**
91st day and after
(once lifetime reserve days are used)
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
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First 20 days All approved amounts $0 $0
21st through 100th day All but $164.50 a day Up to $164.50 a day $0
101st day and after $0 $0 All costs
BLOOD
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First 3 pints $0 3 pints $0
Additional amounts 100% $0 $0
HOSPICE CARE
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
You must meet Medicare's requirements, including a doctor's certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0

*A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

**When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's 'core benefits'. During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

Medicare (Part B) Medical Services - Per Calendar year

MEDICAL EXPENSES - IN OR OUT OF THE HOSPITAL AND 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
First $183. of Medicare Approved Amounts* $0 $0 $183. (Part B deductible)
Remainder of Medicare Approved Amounts Generally 80% Balance, other than up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. Up to $20 per office visit and up to $50 per emergency room visit. The copayment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.
Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All costs
BLOOD
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First 3 pints $0 All costs $0
Next $183. of Medicare Approved Amounts* $0 $0 $183 (Part B deductible)
Remainder of Medicare Approved Amounts 80% 20% $0
CLINICAL LABORATORY SERVICES - TESTS FOR DIAGNOSTIC SERVICES
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
Tests for diagnostic services 100% $0 $0

Parts A & B

HOME HEALTH CARE MEDICARE APPROVED SERVICES
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
Medically necessary skilled care services and medical supplies 100% $0 $0
Durable medical equipment:
First $183. of Medicare Approved Amounts		 $0 $0 $183. (Part B deductible)
Durable medical equipment:
Remainder of Medicare Approved Amounts		 80% 20% $0
FOREIGN TRAVEL - NOT COVERED BY MEDICARE Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA.
SERVICES MEDICARE PAYS PLAN PAYS YOU PAY
First $250 each calendar year $0 $0 $250
Remainder of Charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum

*Once you have been billed $183. of Medicare Approved Amounts for covered services (which are noted with an asterisk), your Part B deductible will have been met for the calendar year.

Medicare Part A and B deductible and coinsurance amounts are set each year by the Department of Health and Human Services.