Plan Rating | n/a |
Premium and Other Important Information | In 2012 the monthly Part B Standard Premium is $99.90 and the annual Part B deductible amount is $140. |
If a doctor or supplier does not accept assignment their costs are often higher which means you pay more. | |
Most people will pay the standard monthly Part B premium. However some people will pay a higher premium because of their yearly income (over $85 000 for singles $170 000 for married couples). For more information about Part B premiums based on income call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may also call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. | |
Doctor and Hospital Choice | You may go to any doctor specialist or hospital that accepts Medicare. |
Inpatient Hospital Care | In 2012 the amounts for each benefit period are: Days 1 - 60: $1 156 deductible Days 61 - 90: $289 per day Days 91 - 150: $578 per lifetime reserve day |
Call 1-800-MEDICARE (1-800-633-4227) for information about lifetime reserve days. | |
Lifetime reserve days can only be used once. | |
"A ""benefit period"" starts the day you go into a hospital or skilled nursing facility. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have." | |
Inpatient Mental Health Care | In 2012 the amounts for each benefit period are: Days 1 - 60: $1 156 deductible Days 61 - 90: $289 per day Days 91 - 150: $578 per lifetime reserve day |
You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital. | |
Skilled Nursing Facility (SNF) | In 2012 the amounts for each benefit period after at least a 3-day covered hospital stay are: Days 1 - 20: $0 per day Days 21 - 100: $144.50 per day |
100 days for each benefit period. | |
"A ""benefit period"" starts the day you go into a hospital or SNF. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have." | |
Home Health Care | $0 copay. |
Hospice | You pay part of the cost for outpatient drugs and inpatient respite care. |
You must get care from a Medicare-certified hospice. | |
Doctor Office Visits | 20% coinsurance |
Chiropractic Services | Supplemental routine care not covered |
20% coinsurance for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers. | |
Podiatry Services | Supplemental routine care not covered. |
20% coinsurance for medically necessary foot care including care for medical conditions affecting the lower limbs. | |
Outpatient Mental Health Care | 40% coinsurance for most outpatient mental health services |
Specified copayment for outpatient partial hospitalization program services furnished by a hospital or community mental health center (CMHC). Copay cannot exceed the Part A inpatient hospital deductible. | |
"""Partial hospitalization program"" is a structured program of active outpatient psychiatric treatment that is more intense than the care received in your doctor's or therapist's office and is an alternative to inpatient hospitalization." | |
Outpatient Substance Abuse Care | 20% coinsurance |
Outpatient Services/Surgery | 20% coinsurance for the doctor's services |
Specified copayment for outpatient hospital facility services Copay cannot exceed the Part A inpatient hospital deductible. | |
20% coinsurance for ambulatory surgical center facility services | |
Ambulance Services | 20% coinsurance |
Emergency Care | 20% coinsurance for the doctor's services |
Specified copayment for outpatient hospital facility emergency services. | |
Emergency services copay cannot exceed Part A inpatient hospital deductible for each service provided by the hospital. | |
You don't have to pay the emergency room copay if you are admitted to the hospital as an inpatient for the same condition within 3 days of the emergency room visit. | |
Not covered outside the U.S. except under limited circumstances. | |
Urgently Needed Care | 20% coinsurance or a set copay |
NOT covered outside the U.S. except under limited circumstances. | |
Outpatient Rehabilitation Services | 20% coinsurance |
Durable Medical Equipment | 20% coinsurance |
Prosthetic Devices | 20% coinsurance |
Diabetes Programs and Supplies | 20% coinsurance for diabetes self-management training |
20% coinsurance for diabetes supplies | |
20% coinsurance for diabetic therapeutic shoes or inserts | |
Diagnostic Tests X-Rays Lab Services and Radiology Services | 20% coinsurance for diagnostic tests and x-rays |
$0 copay for Medicare-covered lab services | |
Lab Services: Medicare covers medically necessary diagnostic lab services that are ordered by your treating doctor when they are provided by a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory that participates in Medicare. Diagnostic lab services are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare does not cover most supplemental routine screening tests like checking your cholesterol. | |
Cardiac and Pulmonary Rehabilitation Services | 20% coinsurance Cardiac Rehabilitation services 20% coinsurance for Pulmonary Rehabilitation services 20% coinsurance for Intensive Cardiac Rehabilitation services |
This applies to program services provided in a doctor+s office. Specified cost sharing for program services provided by hospital outpatient departments. | |
Preventive Services and Wellness/Education Programs | No coinsurance copayment or deductible for the following: |
Kidney Disease and Conditions | 20% coinsurance for renal dialysis |
20% coinsurance for kidney disease education services | |
Outpatient Prescription Drugs | Most drugs are not covered under Original Medicare. You can add prescription drug coverage to Original Medicare by joining a Medicare Prescription Drug Plan or you can get all your Medicare coverage including prescription drug coverage by joining a Medicare Advantage Plan or a Medicare Cost Plan that offers prescription drug coverage. |
Dental Services | Preventive dental services (such as cleaning) not covered. |
Hearing Services | Supplemental routine hearing exams and hearing aids not covered. |
20% coinsurance for diagnostic hearing exams. | |
Vision Services | 20% coinsurance for diagnosis and treatment of diseases and conditions of the eye. |
Supplemental routine eye exams and glasses not covered. | |
Medicare pays for one pair of eyeglasses or contact lenses after cataract surgery. | |
Annual glaucoma screenings covered for people at risk. | |
Over-the-Counter Items | Not covered. |
Transportation | Not covered. |
Acupuncture | Not covered. |
Point of Service | You may go to any doctor specialist or hospital that accepts Medicare. |
Help is available. If you have limited income and resources, you may qualify for help paying your Medicare health care and/or prescription drug coverage costs. For more information, visit socialsecurity.gov, call Social Security at 1-800-772-1213, or apply for help at your State Medical Assistance (Medicaid) office.
If you have questions about Medicare, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.