Original Medicare Pays |
A |
B | C | D | E | F** | G | H | I | J** | K | L |
| Hospital Coinsurance Coinsurance for days 61-90 ($267) and days 91-150 ($534) in hospital; Payment in full for 365 additional lifetime days. | ||||||||||||
| Part B coinsurance Coinsurance for Part B services such as doctor's services, laboratory and x-ray services, durable medical equipment, and hospital outpatioent services. |
50% |
75% |
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| First three pints of blood | 50% |
75% |
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| Hospital Deductible Covers $1,068 in each benefit period. |
50% |
75% |
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| Skilled Nursing Facility (SNF) Daily Coinsurance Days 1-20 you pay $0. Days 21-100 of each benefit period, you pay $133.50 per day. Afer that, you pay all expenses. |
50% |
75% |
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| Part B Annual Deductible Covers $135 per calendar year. |
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| Part B Excess Charges Benefits 80% or 100% of Part B excess charges. (Under Federal law, the excess limit is 15% more than Medicare's approved charge when provider does not take assignment; Under New York State law, the excess limit is 5% for most services.) |
100% |
80% |
100% |
100% |
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| Emergency Care Outside the US Covers 80% of emergency care costs during the first 60 days of each trip, after an annual deductible of $250, up to a maximum lifetime benefit of $50,000. |
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| At-Home Recovery Benefit Up to $40 each visit for custodial care after an illness, injury, or surgery, up to a maximum benefit of $1,600 a year. |
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Preventive Medical Care
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| Hospice Care Coinsurance for respite care and other Part A-covered services. |
50% |
75% |
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| Outpatient Prescription Drugs | ||||||||||||
| Out-of-Pocket Maximum Pays 100% of Part A and Part B coinsurance after annual maximum has been spent. |
*** $4,620 |
*** $2,310 |
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Medigap plans are standardized by the federal government. Not all plans may be available in your area.
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