Coverage Details
Medicare Part A Expenses (2016)
| BENEFIT | MEDICARE PAYS | YOUR RESPONSIBILITY |
| Hospital Confinement | Per benefit period* | Per benefit period* |
| First 60 days | All but $1,288 (Part A deductible) | $1,288 |
| Days 61-90 | All but $322 per day
(Part A coinsurance) | $322-$9,660 |
| Days 91-150 | All but $644 per day | $644-$38,640 |
| Blood |
| First 3 pints (blood deductible) | Nothing | YOUR TOTAL RESPONSIBILITY |
Skilled Nursing Facility
(After a hospital stay for less than 3 nights) | Nothing | YOUR TOTAL RESPONSIBILITY |
| (After 3 nights in the hospital) | | |
| First 20 days | 100% of all costs | $0 |
| Days 21-100 | All but $161 per day | $161-$12,880 |
| Beyond 100 days | Nothing | YOUR TOTAL RESPONSIBILITY |
| Non-Skilled Intermediate & Custodial Care |
| For chronically ill and aged who need help with activities of daily living. | Nothing | YOUR TOTAL RESPONSIBILITY |
| Hospice Care |
| Available for the terminally ill who elect to receive these services. | All but a very limited co-insurance for outpatient drugs and inpatient respite care. | MINIMAL CO-INSURANCE PAYMENT |
* There can be multiple benefit periods per year. A new benefit period begins when you have been out of the hospital for 60 consecutive days.
Medicare Part B Expenses (2016)
| BENEFIT | MEDICARE PAYS | YOUR RESPONSIBILITY |
| Physician Services and other Medical Expenses in or out of the hospital |
| Medicare approved amounts up to $166 | Nothing
(Part B deductible) | $166 |
| Medicare approved amounts over $166 | 80% | 20% of costs |
| Covered charges in excess of Medicare approved amounts, up to any charge limitations established by state or federal law | Nothing | YOUR TOTAL RESPONSIBILITY |
| Blood |
| First 3 pints (blood deductible) | Nothing | YOUR TOTAL RESPONSIBILITY |
Other services covered under Parts A and B
| BENEFIT | MEDICARE PAYS | YOUR RESPONSIBILITY |
| Home Health care Medicare-Approved Services |
| Covered home care visits and medical supplies | 100% | $0 |
| Durable Medical Equipment |
| Medicare approved amounts up to $166 | Nothing
(Part B deductible) | $166 |
| Medicare approved amounts over $166 | 80% | 20% of costs |
| Expenses not covered by Medicare |
| Foreign Travel |
| Medically necessary emergency hospital and medical care | Nothing | YOUR TOTAL RESPONSIBILITY |
WR 9003-3a
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