| |
Plan G
- Medicare Part A - Hospital Services - Per Benefit Period
|
Services / Part A |
In 2003
Medicare
Pays |
Plan G Plan |
You Pay |
HOSPITALIZATION*
Semiprivate room and board,
general nursing and miscellaneous
services and supplies
-First 60 Days |
All but
$840.00 |
$840.00
(Part A
Deductible |
$0 |
|
-61st through 90th
day |
All but
$210.00 a
day |
$210.00 a
day |
$0 |
-91st day and
after
-While using 60 lifetime reserve days |
All but
$420.00 a
day |
$420.00 a
day |
$0 |
-Once lifetime
reserve days are used:
-Additional 365 days |
$0 |
100% of
Medicare
Eligible
Expenses |
$0 |
|
-Beyond the
additional 365 days |
$0 |
$0 |
All costs |
SKILLED NURSING FACILITY CARE*
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
-First 20 days |
All approved
amounts |
$0 |
$0 |
|
-21st through
100th day |
All but
$105.00 a day |
$105.00 a
day |
$0 |
|
-101st day and
after |
$0 |
$0 |
All costs |
BLOOD
-First 3 Pints |
$0 |
3 Pints |
$0 |
|
-Additional
amounts |
100% |
$0 |
$0 |
HOSPICE CARE
Available as long as your doctor
certifies you are terminally ill and you
elect to receive these services |
All but very
limited
coinsurance
for outpatient
drugs and
inpatient
respite care |
$0 |
Balance |
Plan G - Medicare
Part B - Medical Services - Per Calendar Year
|
Services / Part B |
In 2003
Medicare
Pays |
Plan G Pays |
You Pay |
MEDICAL EXPENSES
IN OR OUT OF THE HOSPITAL
AND OUTPATIENT HOSPITAL
TREATMENT: such as physician's
services, inpatient and outpatient
medical and surgical services and
supplies, physical and speech
therapy, diagnostic tests, durable
medical equipment
-First $100.00
of Medicare Approved
Amounts** |
$0 |
$0 |
$100.00
(Part B
Deductible) |
-Remainder of
Medicare Approved
Amounts (after the Part B
Deductible) |
Generally 80% |
Generally 20% |
$0 |
-Part B Excess
Charges (above
Medicare Approved Amounts) |
$0 |
80% |
20% |
BLOOD
-First 3 pints |
$0 |
All costs |
$0 |
-Next $100.00 of
Medicare
Approved Amounts** |
$0 |
$0 |
$100.00
(Part B
Deductible) |
-Remainder of
Medicare
Approved Amounts |
Generally
80% |
Generally
20% |
$0 |
CLINICAL LABORATORY
SERVICES--BLOOD TESTS FOR
DIAGNOSTIC SERVICES |
100% |
$0 |
$0 |
|
|
|
|
|
|
Parts A & B |
In 2002
Medicare
Pays |
Plan G Pays |
You Pay |
HOME HEALTH CARE - MEDICARE
APPROVED SERVICES
Medically necessary skilled care
services and medical supplies |
100% while
approved |
$0 |
All charges
after
Medicare |
Durable medical
equipment
-First $100.00 of Medicare Approved
Amounts** |
$0 |
$0 |
$100.00
(Part B
Deductible) |
-Remainder of
Medicare Approved
Amounts |
80% |
20% |
$0 |
OTHER BENEFITS-NOT
COVERED BY MEDICARE Part B
(Covered under Plan G)
|
Services / Part B |
Medicare
Pays |
Plan G Pays |
You Pay |
FOREIGN TRAVEL-
NOT COVERED BY MEDICARE
Medically necessary emergency
care services beginning during the
first 60 days of each trip outside the
USA
-First $250 of each calendar year |
$0 |
$0 |
$250.00 |
|
-Remainder of
Charges |
$0 |
80% to a
lifetime
benefit
maximum
benefit of
$50,000 |
20% and
amounts
over the
$50,000
lifetime
maximum |
*
A benefit period begins on the first day you receive
service as an inpatient in a hospital and
ends after you have been out of the hospital and have not
received skilled care in any other
facility for 60 days in a row.
**Once you have been billed $100.00 of Medicare Approved
amounts for covered services
(which are noted with an asterisk), your Part B Deductible
will have been met for the calendar
year. Senior American Insurance is not associated with
Medicare, Social Security or any other
Government Agency. |
