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Plan D 2020 Coverage Details

Medicare (Part A) Hospital Services Per Benefit Period
Services Benefit Details Medicare Pays Plan Pays You Pay
Hospitalization1

(Semiprivate room and board, general nursing and miscellaneous services and supplies)

First 60 days All but $1,408 $1,408 (Part A Deductible) $0
Days 61-90 All but $352 a day $352 a day $0
91st day and after

(while using 60 lifetime reserve days)

All but $704 a day $704 a day $0
91st day and after

(once lifetime reserve days are used — additional 365 days)

$0 100% of Medicare eligible expenses $02
91st day and after

(once lifetime reserve days are used — beyond the additional 365 days)

$0 $0 All costs
Skilled Nursing Facility Care1

(You must meet Medicare's requirements, including having been in a hospital for at least three days and entered a Medicare approved facility within 30 days after leaving the hospital)

First 20 days All approved amounts $0 $0
Days 21-100 All but $176 a day Up to $176 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 You must meet Medicare's requirements, including doctor's certification of terminal illness All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care Medicare copayment/coinsurance $0

1A 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.

2Notice: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Basic Benefits." During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

 

Medicare (Part B) Medical Services Per Calendar Year
Services Benefit Details Medicare Pays Plan 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 $198 of Medicare approved amounts3 $0 $0 $198 (Part B deductible)
Remainder of Medicare approved amounts Generally 80% Generally 20% $0
Part B Excess Charges Above Medicare approved amounts  $0 $0 All costs
Blood First 3 pints $0 All costs $0
Next $198 of Medicare approved amounts3 $0 $0 $198 (Part B deductible)
Remainder of Medicare approved amounts 80% 20% $0
Clinical Laboratory Services Tests for diagnostic services 100% $0 $0

3Once you have been billed $198 of Medicare approved amounts for covered services, your part B deductible will have been met for the calendar year.

Medicare Parts A & B
Services Benefit Details Medicare Pays Plan Pays You Pay
Home Health Care

Medicare approved services

Medically necessary skilled care services and medical supplies 100% $0 $0
Durable medical equipment — first $198 of Medicare approved amounts3 $0 $0 $198 (Part B deductible)
Durable medical equipment  — remainder of Medicare approved amounts 80% 20% $0

3Once you have been billed $198 of Medicare approved amounts for covered services, your part B deductible will have been met for the calendar year.

Medicare benefits are subject to change. Please consult the latest Guide to Health Insurance for People with Medicare.

Other Benefits Not Covered by Medicare
Services Benefit Details Medicare Pays Plan Pays You Pay
Foreign Travel

Not covered by Medicare

Medically necessary skilled care services beginning during the first 60 days of each trip outside the USA — first $250 each calendar year $0 $0 $250
Medically necessary skilled care services beginning during the first 60 days of each trip outside the USA — remainder of charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum