|
Modernized Plan G 2019
MEDICARE (PART A) -
HOSPITAL SERVICES - PER
BENEFIT PERIOD |
* 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. |
Service: |
HOSPITALIZATION*
Semiprivate room and
board, general nursing
and miscellaneous
services and supplies: |
|
MEDICARE PAYS |
PLAN PAYS |
YOU PAY |
First 60 days |
All but $1,364 |
$1,364 (Part A
Deductible) |
$0 |
61st through 90th day |
All but $341 a day |
$341 a day |
$0 |
91st day and after: |
|
|
|
While using 60 lifetime
reserve days |
All but $682 a day |
$682 a day |
$0 |
Once lifetime reserve
days are used: |
|
|
|
Additional 365 days |
$0 |
100% of Medicare
Eligible Expenses |
$0** |
Beyond the Additional
365 days |
$0 |
$0 |
All costs |
Service: |
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 |
All approved amounts |
$0 |
$0 |
21st through 100th day |
All
but $170.50 a day |
Up to
$170.50 a day |
$0 |
101st day and after |
$0 |
$0 |
All costs |
Service: |
BLOOD
|
First 3 pints |
$0 |
3 pints |
$0 |
Additional amounts |
100% |
$0 |
$0 |
Service: |
HOSPICE CARE
Available as long as you
meet Medicare's
requirements, your
doctor certifies you are
terminally ill and you
elect to receive these
services |
Outpatient Prescription
Drugs |
All but $5 |
$5 |
$0 |
Inpatient Respite Care |
All but 5% |
5% of Medicare's
approved amount |
$0 |
**NOTICE: 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. |
|
Modernized Plan G 2019
MEDICARE (PART B)
- MEDICAL SERVICES - PER
CALENDAR YEAR* |
* Once you have been
billed $185 of
Medicare-Approved
amounts for covered
services (which are
noted with an asterisk),
your Medicare Part B
Deductible will have
been met for the
calendar year. |
Service: |
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: |
|
MEDICARE PAYS |
PLAN PAYS |
YOU PAY |
First $185 of Medicare
Approved Amounts* |
$0 |
$0 |
$185 (Part B Deductible) |
Remainder of Medicare
Approved Amounts |
Generally 80% |
Generally 20% |
$0 |
Part B Excess Charges
(Above Medicare Approved
Amounts) |
$0 |
100% |
0% |
Service: |
BLOOD |
First 3 pints |
$0 |
All costs |
$0 |
Next $185 of Medicare
Approved Amounts* |
$0 |
$0 |
$185 (Part B Deductible) |
Remainder of Medicare
Approved Amounts |
80% |
20% |
$0 |
Service: |
CLINICAL LABORATORY
SERVICES |
Tests for Diagnostic
Services |
100% |
$0 |
$0 |
|
PARTS A & B |
Service: |
HOME HEALTH CARE
Medicare Approved
Services: |
|
MEDICARE PAYS |
PLAN PAYS |
YOU PAY |
Medically necessary
skilled care services
and medical supplies |
100% |
$0 |
$0 |
Durable medical
equipment: |
|
|
|
First $185 of Medicare
Approved Amounts* |
$0 |
$0 |
$185 (Part B Deductible) |
Remainder of Medicare
Approved Amounts |
80% |
20% |
$0 |
|
OTHER BENEFITS -
NOT COVERED BY
MEDICARE
|
Service: |
FOREIGN TRAVEL NOT
COVERED BY MEDICARE
Medically necessary
emergency care
services beginning
during the first 60
days of each trip
outside the USA:
|
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 |