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Medicare Out of Pocket Expenses

ORIGINAL MEDICARE OUT OF POCKET EXPENSES...

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.

SAMPLE MEDICARE ADVANTAGE PLAN OUT OF POCKET EXPENSES

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.

 

Health Insurance : Life Insurance : Long Term Care : Medicare Supplemental : Disablity Income
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Prescott, Arizona 86301
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