The table below lists cost information for services covered under each It's Your Choice Medicare plan design option. 
 

 

Health Plan Medicare &
Medicare Advantage

Medicare Plus2

Annual Medical Deductible1

Medicare pays: Allowable services after Part A ($1,340) and Part B ($183) deductibles 

Plan pays: After $500 individual / $1,000 family deductible: Part A inpatient hospital deductible of $1,340 and Part B deductible of $183 

You pay: $500 individual / $1,000 family plan deductible, then as described below

Medicare pays: Allowable services after Part A ($1,340) and Part B ($183) deductibles 

Plan pays: Part A inpatient hospital deductible of $1,340 and Part B deductible of $183 

You pay: $0

Annual Medical Coinsurance1

Medicare pays: For Part A, varying coinsurance as listed below for hospital inpatient and skilled nursing facility care. After Part B deductible, 80% 

Plan pays: After plan deductible, Part B deductible and 20% coinsurance 

You pay: After plan deductible, $0

Medicare pays: For Part A, varying coinsurance as listed below for hospital inpatient and skilled nursing facility care. After Part B deductible, 80% 

Plan pays: Part B deductible and 20% coinsurance 

You pay: $0

Annual Medical Out-of-Pocket Limit (OOPL)

None

None

Outpatient illness/injury related services

Medicare pays: After Part B deductible, 80% 

Plan pays: After plan deductible, Part B deductible and 20% coinsurance 

You pay: After plan deductible, $0

Medicare pays: After Part B deductible, 80% 

Plan pays: Part B deductible and 20% coinsurance 

You pay: $0

Emergency Room Copay

Medicare pays: After Part B deductible, 80% 

Plan pays: Part B deductible and 20% coinsurance 

You pay: After your plan deductible, $60 copayment (Waived if admitted as an inpatient directly from the emergency room or for observation for 24 hours or longer.)

Medicare pays: After Part B deductible, 80% 

Plan pays: Part B deductible and 20% coinsurance 

You pay: $0

Hospital 

Semiprivate room and board, and miscellaneous hospital services and supplies such as drugs, X-rays, lab tests and operating room. 
“Lifetime reserve” days are a one-time additional 60 days of hospital coverage paid by Medicare.

Medicare pays: After Part A deductible; full cost for the first 60 days

61st to 90th day, all but $335 per day

91st to 150th day, all but $670 per day (if using “lifetime reserve”), if “lifetime reserve” days are exhausted, $0

Plan pays: 100% as medically necessary. No day limit

Health Plan Medicare will pay plan providers only

Medicare Advantage will pay any provider who will accept Medicare Advantage and bill UnitedHealthcare

You pay: After plan deductible, $0

Medicare pays: After Part A deductible; full cost for the first 60 days

61st to 90th day, all but $335 per day

91st to 150th day, all but $670 per day (if using “lifetime reserve), if “lifetime reserve” days are exhausted, $0

Plan pays: Initial Part A deductible of $1,340 for the first 60 days
61st to 90th day, $335 per day
91st to 150th day, $670 per day if under “lifetime reserve” period 

You pay: $0 for first 90 days of confinement, and up to 150 under “lifetime reserve.” Once “lifetime reserve” is exhausted, you pay the full cost after 90 days

Licensed Skilled Nursing Facility

Medicare covered services in a Medicare approved facility

Health Plan Medicare requires a 3-day hospital stay

Medicare Advantage has no 3-day requirement

Medicare pays: 100% for the first 20 days
21st to 100th days, all but $167.50 per day
Beyond 100 days, $0

Plan pays: After plan deductible, 100% as medically necessary, plan providers only. 120 day limit
Beyond 120 days, $0

You pay: After plan deductible, $0 for the first 120 days, full cost after 120 days

Requires a 3-day period of hospital stay

Medicare pays: 100% for the first 20 days
21st to 100th days, all but $167.50 per day
Beyond 100 days, $0 

Plan pays: 21st to 100th days, $167.50 per day 101st to 120th days, all covered services up to a maximum of 120 days per benefit period
Beyond 120 days, $0 

You pay: $0 for the first 120 days, full cost after 120 days

Licensed Skilled Nursing Facility (Non-Medicare approved facility)

If admitted within 24 hours following a hospital stay

Medicare pays: $0 

Plan pays: After plan deductible: 120 days per benefit period for skilled care in a facility licensed in a state 

You pay: After plan deductible, full cost after 120 days

Medicare pays: $0 

Plan pays: Maximum daily rate for up to 30 days per confinement; covers only the same type of expenses normally covered by Medicare in a Medicare-approved facility 

You pay: $0 for eligible expenses for the first 30 days, full cost after 30 days

Medicare Approved: Medical Supplies, Durable Medical Equipment and Durable Diabetic Equipment and Related Supplies

Medicare Pays: After Part B deductible, 80%

Plan pays: After plan deductible,
If you have not met the Part B deductible, 80%

If you have met the Part B deductible, but you have not met the $500 OOPL per participant, 0%

If you have met the Part B deductible, and also the $500 OOPL per participant, 20%

You pay: After plan deductible, 20% up to $500 OOPL per participant, after OOPL, $0

Medicare Pays: After Part B deductible, 80%

Plan pays: Part B deductible and 20% coinsurance

You pay: $0

Not Covered by Medicare: Medical Supplies, Durable Medical Equipment and Durable Diabetic Equipment and Related Supplies

Medicare pays: None

Plan pays: After plan deductible,
If you have not met the $500 OOPL per participant, 80%

If you have met the $500 OOPL per participant, 100%

You pay: After plan deductible, 20% up to $500 OOPL per participant, after OOPL, $0

Medicare pays: None

Plan pays: None

You pay: Full cost of supplies

Home Health Care 

You’re under the care of a doctor and the doctor certifies you need part-time skilled nursing care, part-time home health aide care, physical therapy, occupational therapy, speech-language pathology services, or medical social services

Medicare pays: 100% of charges for visits considered medically necessary by Medicare, generally fewer than 7 days a week, less than 8 hours a day and 28 or fewer hours per week for up to 21 days 

Plan pays: After plan deductible, 100% for 50 visits per year, plan may approve an additional 50 visits

Medicare Advantage has no visit limits 

You pay: After plan deductible, full costs of visits not covered by Medicare and the plan beyond the 50 (or if approved, 100) visits per year

Medicare pays: 100% of charges for visits considered medically necessary by Medicare, generally fewer than 7 days a week, less than 8 hours a day and 28 or fewer hours per week for up to 21 days 

Plan pays: 100% for up to 365 visits per year 

You pay: Full costs of visits beyond 365 per year

Routine Hearing Exam

Medicare pays: None 

Plan pays: After plan deductible, 100% 

You pay: After plan deductible, $0

Medicare pays: None 

Plan pays: None 

You pay: Full cost of hearing exam

Hearing Exam for Illness or Disease

Medicare pays: After Part B deductible, 80% 

Plan pays: After plan deductible, deductible and 20% coinsurance 

You pay: After plan deductible, $0

Medicare pays: After Part B deductible, 80%

Plan pays: Deductible and 20% coinsurance 

You pay: $0

Hearing Aid (per ear)

Medicare pays: No coverage for adults 

Plan pays: After plan deductible, 80% for adults up to plan paid $1,000 every three years (does not count toward OOPL) 

You pay: After plan deductible, 20% coinsurance and 100% of costs exceeding plan payment of $1,000

Medicare pays: No coverage for adults 

Plan pays: None 

You pay: Full cost of hearing aid

1 Medicare deductible and coinsurance amounts listed are from 2018. Medicare deductible amounts are listed only to describe how your benefits work under the available plan designs. Your out-of-pocket costs are indicated in the "You pay" line.

2 IYC Medicare Plus pays only for services that Medicare covers. You pay the full cost of any non-covered services.

Was this page helpful?