Services |
Benefit |
Medicare Pays |
You Pay |
Medical
Expense: physician's services,
inpatient and outpatient medical services and supplies, physical and
speech therapy, ambulance, etc |
Medicare pays for medical services in or out of the
hospital |
80%
of approved amount (after $124 deductible) |
$124
deductible* plus 20% of approved amount (plus any charge up to 15%
above approved amount)**
20% for all outpatient physical, occupational, and speech-language therapy
services |
Home
Health Care only if you do not have Medicare Part A |
Visits limited to medically necessary skilled care |
100%
of approved amount; 80% of approved amount for durable medical equipment |
Nothing
for services; 20% of approved amount for durable medical equipment |
| Hospital services and supplies |
91 - 150 Days
(60
Reserve Days) |
Covered services except
for a daily coinsurance amount |
$476 a day |
Skilled Nursing Facility
Footnote 2 |
1- 20 Days |
100% of Approved Amount |
Nothing |
21 - 100 Days |
Covered services except
for a daily coinsurance amount |
$119 a day |
Over 100 Days |
Nothing |
Everything |
| Home Health Care |
Visits limited to
medically necessary skilled care, unlimited as long as you meet Medicare
requirements for home health benefits |
Full costs of services;
80% of approved amount for durable medical equipment |
Nothing for services;
20% of approved amount for durable medical equipment |
| Hospice Care |
As long as doctor
certifies need |
All but limited costs
for outpatient drugs and inpatient respite care |
Limited cost sharing
for outpatient drugs and inpatient respite care |
| Blood |
Unlimited during benefit
period, if medically necessary |
All but first three
pints per calendar year |
For first three pints |
| Footnote
1 -- 60 reserve days may be used only once |
| Footnote 2 -- 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 or skilled nursing facility for 60 days
in a row. You must have been in a hospital for at least three days and enter a Medicare-approved facility generally within 30 days after medical
discharge. Medicare and private insurance will not pay for most nursing home care. |