| HOSPITALIZATION Semiprivate room and board, general nursing and misc. services and supplies First 60 days 61st thru 90th day 91st day and after: -- (While using 60 lifetime reserve days) - Once lifetime reserve days are used: -- Additional 365 days -- Beyond add'l 365 days |
All but $1,600 All but $400 / day All but $800 / day $0 $0 |
$0 $400 $800 100% 0% |
$1,600 $0 $0 $0 100% |
| 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 - Copay/Day 21st - 100th day- Copay/Day 101st day and after |
All approved amounts All but $200 / day $0 |
$0 $0 $0 |
$0 $200 100% |
| BLOOD First 3 pints Additional amounts |
$0 100% |
100% $0 |
$0 $0 |
| HOSPICE CARE You must meet Medicare's requirements, including a doctor's certification of terminal illness. |
All except small copayment or coinsurance. |
Remaining balance |
$0 |
| 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. First $226 of Medicare Approved Amounts |
$0 |
$0 |
$226 |
| Remainder of Part B Approved claims after $226 DR Visit ER Visit |
80% 80% 80% |
20% 20% 20% |
0% 0% 0% |
| EXCESS CHARGES |
$0 |
$0 |
100% |
| BlOOD First 3 pints Next $226 of Medicare approved amounts Remainder of Medicare approved amounts |
$0 $0 80% |
100% $0 20% |
0% $226 0% |
| CLINICAL LABORATORY SERVICES Tests for Diagnostic Services |
100% |
0% |
0% |
| HOME HEALTH CARE Medicare approved services Medically necessary skilled care services and medical supplies |
100% |
0% |
0% |