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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