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The following are examples of some of the more common out of pocket expenses under original Medicare:
- Inpatient Hospital Care: You pay for days 1-60 an initial deductible of $1,100. For days 61-90, you pay $275 each day. For days 91-150, you pay $550 per day. You pay 100% thereafter.
- Skilled Nursing Facility: For days 1-20 you pay nothing. For days 21-100 you pay $137.50 per day. You pay 100% thereafter.
- Doctor Office Visits: After you pay your $155 annual deductible, you pay 20% of Medicare approved charges/amounts. If the doctor does not accept Medicare assignment as payment in full, you must pay an additional 15%.
- Chiropractic Services: You pay 20% of Medicare approved charges/amounts for manual manipulation of the spine to correct subluxation. If the chiropractor does not accept Medicare assignment as payment in full, you must pay an additional 15%.
- Outpatient Surgery: You pay 20% of Medicare approved amounts for the doctor and the outpatient facility charges.
- Ambulance: You pay 20% of Medicare approved amounts.
- Emergency Care: You pay 20% of the facility charge and 20% of the emergency room physician’s charges.
- Diagnostic Tests, X-Rays and Lab Services: You pay 20% of Medicare approved amounts except for approved lab services.
The following are examples of some of the more common out of pocket expenses that might exist under a sample Medicare Advantage plan that is not specific to any company:
- Out of Pocket Maximum: $4,900 per year.
- Inpatient Hospital Care: For days 1-7, you pay $195 per day. You pay nothing for days 6-150.
- Skilled Nursing Facility: You pay nothing for days 1-7. For days 8-100, you pay $84 per day.
- Doctor Office Visits: You pay $15 for each primary care doctor visit. You pay $35 for each specialist doctor visit.
- Chiropractic Services: You pay $35 for each Medicare approved visit which includes manual manipulation of the spine to correct subluxation.
- Outpatient Surgery: You pay $100 for each Medicare covered outpatient surgery.
- Ambulance: You pay $100 for Medicare covered ambulance services.
- Emergency Care: You pay $50 for each Medicare covered emergency room visit.
- Diagnostic Tests, X-Rays and Lab Service: You pay $15 for lab services, $15 for x-rays and $15 for complex tests such as CT scans. Other tests such as an MRI and/or PET scan are $100.
- Drug Coverage: May or may not have drug coverage depending on the specific plan.
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