Services |
Medicare Pays |
Plan Pays |
You Pay |
Medically necessary skilled care services and medical supplies |
100% |
$0 |
$0 |
Durable Medical Equipment:
Services |
Medicare Pays |
Plan Pays |
You Pay |
First $166 of Medicare Approved Amounts3 |
$0 |
$166 (Part B Deductible) |
$0 |
Remainder of Medicare Approved Amounts |
80% |
20% |
$0 |
Foreign Travel—Not Covered by Medicare
Medically necessary emergency care services beginning during the first 60 days of each trip outside the USA.
Services |
Medicare Pays |
Plan Pays |
You Pay |
First $250 each calendar year |
$0 |
$0 |
$250 |
Remainder of Charges |
$0 |
80% to a lifetime maximum benefit of $50,000 |
20% and amounts over the $50,000 lifetime maximum |