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PART A - Hospital Insurance - Covered Services
Benefit
Medicare Pays
You Pay
Hospitalization
Semi-private room, general nursing, misc.services.
First 60 days All but $840 $840
61st to 90th day All but $210 $210 per day
91st to 150th day All but $420 per day $420 per day
Beyond 150 days Nothing All charges
Skilled Nursing Facility Care
After hospital stay
First 20 days 100% if approved Nothing
21st to 100th day All but $105 per stay $105 per stay
Beyond 100 days Nothing All charges
Home Health Care
Medically necessary skilled-care, therapy
Part-time care 100% if approved Nothing
Hospice Care
For the terminally ill
As long as doctor certifies need All but limited costs for drugs & respite care Limited costs for drugs & respite care
Blood Blood All but first three pints First three pints
 
PART B - Medical Insurance - Covered Services
Benefit
Medicare Pays
You Pay
Medical Expenses
Physician services & medical supplies
Medical services in and out of the hospital 80% if approved
(after deductible*)
20% if approved
(after deductible*)
plus excess charges
Clinical Laboratory Diagnostic tests 100% if approved Nothing
Home Health Care
Medically necessary skilled-care, therapy
Part-time care 100% if approved Nothing
Durable Medical Equipment (DME) Prescribed by doctor for use in your home 80% if approved
(after deductible*)
20% if approved
(after deductible*)
plus excess charges
Outpatient Hospital Treatment Unlimited if medically necessary A fee schedule amount
(after deductible*)
Coinsurance or fixed copayment amount, which varies according to the service (after deductible*)
Blood Blood All but first three pints First three pints

* A single, yearly $100 deductible covers all Part B services.