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MEDICARE PART A
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HOSPITALIZATION
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Semi-private room and board, general nursing and miscellaneous services and supplies.
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First 60 days
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All but $1,156
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$1,156 Part A Deductible
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$0 After You Have
Satisfied Your Annual
Plan Deductible
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Days 61 through 90
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All but $289 per day
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$289 per day
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Days 91 through 150 (60 lifetime reserve days)
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All but $578 per day
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$578 per day
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Additional 365 days
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$0
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100% of Medicare
Eligible Expenses
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Private Duty Nursing Benefits Available with Seniors Choice Optional Plans
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SKILLED NURSING FACILITY
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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.
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First 20 days
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All approved amounts
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$0
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$0 After You Have
Satisfied Your Annual
Plan Deductible
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Days 21 through 100
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All but $144.50 per day
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Up to $144.50 per day
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Days 101 and after
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$0
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$0
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100%
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Additional Skilled Nursing Facility Benefits Available with Seniors Choice Optional Plans
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BLOOD
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First 3 pints
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$0
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100%
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$0 After You Have
Satisfied Your Annual
Plan Deductible
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Additional Amounts
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100%
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$0
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MEDICARE PART B
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MEDICAL SERVICES
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In or out of the hospital and Outpatient Hospital Treatment - All Part B services covered after Annual Plan Deductible has been satisfied and the co-payment amount has been paid. Medicare Part B deductible is included in the Annual Plan Deductible.
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First $140 of Medicare approved amounts
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$0
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$140
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*Co-pay After You Have Satisfied Your Annual Plan Deductible
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Remainder of Medicare approved amounts
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80%
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20%
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Part B Excess Charges - above
Medicare approved amounts
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$0
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100%
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Medical Services Co-Payment Amounts by Service
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Doctor's Office Visit per visit
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$10 Co-pay
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X-rays or Lab Work in Doctor's Office per visit
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$10 Co-pay
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X-rays or Lab Work in Outpatient Facility per visit
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$20 Co-pay
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Outpatient Services per visit
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$20 Co-pay
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Emergency Room Professional Services per visit (Non-Hospital Admission)
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$100 Co-pay
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Durable Medical Equipment
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$10 Co-pay
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*Co-payments apply after the Annual Plan Deductible has been satisfied
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BLOOD
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First 3 pints
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$0
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100%
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$0 After You Have
Satisfied Your Annual
Plan Deductible
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Additional Amounts
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80%
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20%
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CLINICAL LABORATORY SERVICES
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Blood tests for Diagnostic Services
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100%
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0%
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$10 After You Have
Satisfied Your Annual
Plan Deductible
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MEDICARE PARTS A & B
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HOME HEALTH SERVICES
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Covered when provided by a Medicare certified Home Health Agency.
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Limited to reasonable and necessary
part-time or intermittent skilled care
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100%
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$0
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$0 After You Have
Satisfied Your Annual
Plan Deductible
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Health equipment not limited to hospital beds, oxygen and medical supplies for use at home
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80%
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20%
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At Home Recovery Benefits Available with Seniors Choice Optional Plans
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FOREIGN TRAVEL EMERGENCY CARE
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Benefits provided for Medicare approved expenses during first 60 days of a trip outside USA. After a $250 calendar year deductible, Seniors Choice Plan pays at 80%, up to $50,000 lifetime maximum.
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