The table below lists cost information for services covered under each Medicare plan design option.
Health Plan Medicare |
Medicare Advantage |
Medicare Plus2 |
|
---|---|---|---|
Annual Medical Deductible1
|
Medicare pays: Allowable services after Part A ($1,600) and Part B ($226) deductibles Plan pays: Part A inpatient hospital deductible of $1,600 and Part B deductible of $226 You pay: $0 |
Medicare pays: Allowable services after Part A ($1,600) and Part B ($226) deductibles Plan pays: Part A inpatient hospital deductible of $1,600 and Part B deductible of $226 You pay: $0 |
Medicare pays: Allowable services after Part A ($1,600) and Part B ($226) deductibles Plan pays: Part A inpatient hospital deductible of $1,600 and Part B deductible of $226 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: For Part A, varying amounts as listed below for hospital and skilled nursing facility care. For Part B deductible and 20% coinsurance You pay: $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: For Part A, varying amounts as listed below for hospital and skilled nursing facility care. For Part B deductible and 20% coinsurance You pay: $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: For Part A, varying amounts as listed below for hospital and skilled nursing facility care. For Part B deductible and 20% coinsurance You pay: $0 |
Annual Medical Out-of-Pocket Limit (OOPL) |
You pay: $0 Except for up to $500 per individual for durable medical equipment as listed below |
You pay: $0 Except for up to $500 per individual for durable medical equipment as listed below |
You pay: $0 |
Dental Implants |
Medicare pays: $0 Plan pays: Up to $1,000 per tooth You pay: 100% of costs exceeding plan payment of $1,000 |
Medicare pays: $0 Plan pays: Up to $1,000 per tooth You pay: 100% of costs exceeding plan payment of $1,000 |
Medicare pays: $0 Plan pays: $0 You pay: 100%, Full cost |
Durable Medical Equipment (including Durable Diabetic Equipment and Related Supplies) and Other Medical Supplies Medicare approved |
Medicare pays: After Part B deductible, 80% Plan pays: If you have not met the Part B deductible, 20% 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: 20% up to $500 OOPL per participant, after OOPL, $0 |
Medicare pays: After Part B deductible, 80% Plan pays: If you have not met the Part B deductible, 20% 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: 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 |
Durable Medical Equipment (including Durable Diabetic Equipment and Related Supplies) and Other Medical Supplies Not covered by Medicare |
Medicare pays: None Plan pays: If you have not met the $500 OOPL per participant, 80% If you have met the $500 OOPL per participant, 100% You pay: 20% up to $500 OOPL per participant, after OOPL, $0 |
Medicare pays: None Plan pays: If you have not met the $500 OOPL per participant, 80% If you have met the $500 OOPL per participant, 100% You pay: 20% up to $500 OOPL per participant, after OOPL, $0 |
Medicare pays: None Plan pays: None You pay: 100%, Full cost of supplies |
Emergency Room Copay |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance You pay: $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: $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 |
Foot care (podiatry) Covered services include the diagnosis, medical, or surgical treatment of injuries and diseases of the feet |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance for medically necessary services You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance for medically necessary services You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance for medically necessary services You pay: $0 |
Foot care (podiatry) Not covered by Medicare Services include |
Medicare pays: $0 Plan pays: $0 You pay: 100%, Full cost |
Medicare pays: $0 Plan pays: Up to 6 visits per year You pay: $0 Up to 6 visits per year |
Medicare pays: $0 Plan pays: $0 You pay: 100%, Full cost |
Hearing Aid (per ear every 3 years) |
Medicare pays: $0 Plan pays: 80% for adults up to plan paid $1,000 (does not count toward OOPL) You pay: 20% coinsurance and 100% of costs exceeding plan payment of $1,000 |
Medicare pays: $0 Plan pays: 80% for adults up to plan paid $1,000 (does not count toward OOPL) You pay: 20% coinsurance and 100% of costs exceeding plan payment of $1,000 |
Medicare pays: $0 Plan pays: $0 You pay: 100%, Full cost of hearing aid |
Hearing Exam for Illness or Disease |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance You pay: $0 |
Hearing Exam (Routine) |
Medicare pays: $0 Plan pays: 100% You pay: $0 |
Medicare pays: $0 Plan pays: 100% You pay: $0 |
Medicare pays: $0 Plan pays: $0 You pay: 100%, Full cost of hearing exam |
Home Health Care Visits 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: Any amounts after Medicare pays for 50 visits per year (plan may approve an additional 50 visits) You pay: $0 except for cost 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: Any amounts after Medicare pays for up to 365 visits per year You pay: $0 except for cost of visits not covered by Medicare |
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: Any amounts after Medicare pays for up to 365 visits per year You pay: $0 except for cost of visits not covered by Medicare |
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 $400 per day 91st to 150th day, all but $800 per day (if using “lifetime reserve”), if “lifetime reserve” days are exhausted, $0 Plan pays: Any amounts after Medicare pays as medically necessary. No day limit Health Plan Medicare will pay plan providers only You pay: $0 |
Medicare pays: After Part A deductible; full cost for the first 60 days 61st to 90th day, all but $400 per day 91st to 150th day, all but $800 per day (if using “lifetime reserve”), if “lifetime reserve” days are exhausted, $0 Plan pays: Any amounts after Medicare pays as medically necessary. No day limit Medicare Advantage will pay any provider that accepts Medicare, is willing to treat you, and bills UnitedHealthcare You pay: $0 |
Medicare pays: After Part A deductible; full cost for the first 60 days 61st to 90th day, all but $400 per day 91st to 150th day, all but $800 per day (if using “lifetime reserve”), if “lifetime reserve” days are exhausted, $0 Plan pays: Initial Part A deductible for the first 60 days 61st to 90th day, $400 per day 91st to 150th day, $800 per day if under “lifetime reserve” period You pay: $0 for first 120 days of confinement, and up to 150 under “lifetime reserve.” Once “lifetime reserve” is exhausted, you pay the full cost after 120 days |
Illness/injury-related outpatient services |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance You pay: $0 |
Kidney Disease Treatment - Dialysis For transplant, see Hospital benefit |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance up to $30,000 annual max on all treatments for kidney disease You pay: $0 except for full cost beyond $30,000 plan payment for all kidney disease |
Oral Surgery & Specified Dental Services in the Certificate of Coverage (ET-2180) |
Medicare pays: $0 Plan pays: 100% for specified services You pay: $0 for specified services |
Medicare pays: $0 Plan pays: 100% for specified services You pay: $0 for specified services |
Medicare pays: $0 Plan pays: $0 You pay: 100%, Full cost |
Skilled Nursing Facility Medicare-covered services in a Medicare-approved facility |
Requires a 3-day hospital stay Medicare pays: 100% for the first 20 days 21st to 100th days, all but $200 per day Beyond 100 days, $0 Plan pays: After Medicare pays, 100% as medically necessary, for the first 120 days per benefit period; plan providers only Beyond 120 days, $0 You pay: $0 for the first 120 days, full cost after 120 days |
Has no 3-day requirement Medicare pays: 100% for the first 20 days 21st to 100th days, all but $200 per day Beyond 100 days, $0 Plan pays: After Medicare pays, 100% as medically necessary, for the first 120 days per benefit period Beyond 120 days, $0 You pay: $0 for the first 120 days, full cost after 120 days |
Requires a 3-day hospital stay Medicare pays: 100% for the first 20 days 21st to 100th days, all but $200 per day Beyond 100 days, $0 Plan pays: After Medicare pays, 100% as medically necessary, for the first 120 days per benefit period Beyond 120 days, $0 You pay: $0 for the first 120 days, full cost after 120 days |
Skilled Nursing Facility (Non-Medicare approved facility) If admitted within 24 hours following a hospital stay |
Medicare pays: $0 Plan pays: 120 days per benefit period for skilled care in a facility licensed in a state; plan providers only You pay: $0 for the first 120 days, full cost after 120 days |
Medicare pays: $0 Plan pays: 120 days per benefit period for skilled care in a facility licensed in a state You pay: $0 for the first 120 days, 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 |
Therapy- Physical, Speech, and Occupational |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance for 50 visits per year, plan may approve an additional 50 visits You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: Part B deductible and 20% coinsurance for medically necessary visits You pay: $0 |
Medicare pays: After Part B deductible, 80% Plan pays: After Medicare pays, 100% for medically necessary visits You pay: $0 |
TMJ- medically-necessary treatment for the correction of temporomandibular (TMJ) disorders, surgical or non-surgical Not covered by Medicare |
Medicare pays: $0 Plan pays: Up to $1,250 for surgical, diagnostic and nonsurgical treatment per year You pay: 100% of costs exceeding plan payment of $1,250 |
Medicare pays: $0 Plan pays: Up to $1,250 for surgical, diagnostic and nonsurgical treatment per year You pay: 100% of costs exceeding plan payment of $1,250 |
Medicare pays: $0 Plan pays: $0 You pay: 100%, Full cost |
1Medicare deductible and coinsurance amounts listed are from 2023. 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.
2Medicare Plus pays only for services that Medicare covers. You pay the full cost of any non-covered services.