
| Medicare Pays | Plan Pays | |
|---|---|---|
| Medicare Part A Hospital Coverage | ||
| First 60 Days | 100% after Part A deductible | $0 |
| Coinsurance 61-90 days | All but $267 per day | $267 per day |
| Coinsurance 91-150 days (Lifetime reserve) | All but $534 per day | $534 per day |
| Extended Hospital Coverage (Up to an additional 365 days in your lifetime) | Nothing | All eligible expenses |
| Benefit for blood | All but 3 pints | 3 pints |
| Skilled Nursing Facility Care | ||
| First 20 Days | 100% | $0 |
| Coinsurance 21-100 days | All but $133.50 per day | $0 |
| Medicare Part B Physician’s Services and Supplies | ||
| Deductible | Nothing | $0 |
| Coinsurance | 80% | 20% |
| Excess Benefits | Nothing | $0 |
| Benefit for blood | All but 3 pints | 3 pints |
| Additional Benefits | ||
| Emergency Care Recieved Outside the United States | Nothing | $0 |
| At-Home Recovery Visits | Nothing | $0 |
| Medicare Pays | Plan Pays | |
|---|---|---|
| Medicare Part A Hospital Coverage | ||
| First 60 Days | $100% after Part A deductible | $1,068 (Part A deductible) |
| Coinsurance 61-90 days | All but $267 per day | $267 per day |
| Coinsurance 91-150 days (Lifetime reserve) | All but $534 per day | $534 per day |
| Extended Hospital Coverage (Up to an additional 365 days in your lifetime) | Nothing | All eligible expenses |
| Benefit for blood | All but 3 pints | 3 pints |
| Skilled Nursing Facility Care | ||
| First 20 Days | 100% | $0 |
| Coinsurance 21-100 days | All but $133.50 per day | $0 |
| Medicare Part B Physician’s Services and Supplies | ||
| Deductible | Nothing | $0 |
| Coinsurance | 80% | 20% |
| Excess Benefits | Nothing | $0 |
| Benefit for blood | All but 3 pints | 3 pints |
| Additional Benefits | ||
| Emergency Care Recieved Outside the United States | Nothing | $0 |
| At-Home Recovery Visits | Nothing | $0 |
| Medicare Pays | Plan Pays | |
|---|---|---|
| Medicare Part A Hospital Coverage | ||
| First 60 Days | $100% after Part A deductible | $1,068 (Part A deductible) |
| Coinsurance 61-90 days | All but $267 per day | $267 per day |
| Coinsurance 91-150 days (Lifetime reserve) | All but $534 per day | $534 per day |
| Extended Hospital Coverage (Up to an additional 365 days in your lifetime) | Nothing | All eligible expenses |
| Benefit for blood | All but 3 pints | 3 pints |
| Skilled Nursing Facility Care | ||
| First 20 Days | 100% | $0 |
| Coinsurance 21-100 days | All but $133.50 per day | Up to $133.50 per day |
| Medicare Part B Physician’s Services and Supplies | ||
| Deductible | Nothing | $135 |
| Coinsurance | 80% | 20% |
| Excess Benefits | Nothing | $0 |
| Benefit for blood | All but 3 pints | 3 pints |
| Additional Benefits | ||
| Emergency Care Recieved Outside the United States | Nothing | $50,000 Lifetime maximum |
| At-Home Recovery Visits | Nothing | $0 |
| Medicare Pays | Plan Pays | |
|---|---|---|
| Medicare Part A Hospital Coverage | ||
| First 60 Days | $100% after Part A deductible | $1,068 (Part A deductible) |
| Coinsurance 61-90 days | All but $267 per day | $267 per day |
| Coinsurance 91-150 days (Lifetime reserve) | All but $534 per day | $534 per day |
| Extended Hospital Coverage (Up to an additional 365 days in your lifetime) | Nothing | All eligible expenses |
| Benefit for blood | All but 3 pints | 3 pints |
| Skilled Nursing Facility Care | ||
| First 20 Days | 100% | $0 |
| Coinsurance 21-100 days | All but $133.50 per day | Up to $133.50 per day |
| Medicare Part B Physician’s Services and Supplies | ||
| Deductible | Nothing | $135 |
| Coinsurance | 80% | 20% |
| Excess Benefits | Nothing | 100% up to Medicare’s limit |
| Benefit for blood | All but 3 pints | 3 pints |
| Additional Benefits | ||
| Emergency Care Recieved Outside the United States | Nothing | $50,000 Lifetime maximum |
| At-Home Recovery Visits | Nothing | $0 |
| Medicare Pays | Plan Pays | |
|---|---|---|
| Medicare Part A Hospital Coverage | ||
| First 60 Days | $100% after Part A deductible | $1,068 (Part A deductible) |
| Coinsurance 61-90 days | All but $267 per day | $267 per day |
| Coinsurance 91-150 days (Lifetime reserve) | All but $534 per day | $534 per day |
| Extended Hospital Coverage (Up to an additional 365 days in your lifetime) | Nothing | All eligible expenses |
| Benefit for blood | All but 3 pints | 3 pints |
| Skilled Nursing Facility Care | ||
| First 20 Days | 100% | $0 |
| Coinsurance 21-100 days | All but $133.50 per day | Up to $133.50 per day |
| Medicare Part B Physician’s Services and Supplies | ||
| Deductible | Nothing | $135 |
| Coinsurance | 80% | 20% |
| Excess Benefits | Nothing | 80% up to Medicare’s limit |
| Benefit for blood | All but 3 pints | 3 pints |
| Additional Benefits | ||
| Emergency Care Recieved Outside the United States | Nothing | $50,000 Lifetime maximum |
| At-Home Recovery Visits | Nothing | $1,600 Annual Maximum |