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)
Medicare approved

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
• Preventive treatment of the foot
• Removal of corns and calluses
• Trimming, cutting, and clipping of nails
• Wart care

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)
Not covered by Medicare

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)
Not covered by Medicare

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.