The table below lists cost information for services covered under each Medicare plan design option.
|
Health Plan Medicare |
Medicare Advantage2 |
Medicare Plus3 |
|
|---|---|---|---|
| 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: $0 Plan pays: Part A inpatient hospital deductible ($1,600), Part B deductible ($226), and allowable services after the deductibles are met. 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: $0 Plan pays: For Part A, varying amounts as listed below for hospital and skilled nursing facility care. For Part B, deductible and 100% 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: $0 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, 80% If you have met the Part B deductible, and also the $500 OOPL per participant, 100% 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: $0 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: $0 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: $0 Plan pays: $0 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 copay (waived if admitted as an inpatient directly from the emergency room or for observation for 24 hours or longer) |
Medicare pays: $0 Plan pays: Part B deductible and 100% coinsurance You pay: $60 copay (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: $0 Plan pays: Part B deductible and 100% 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: $0 Plan pays: Part B deductible and 100% 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: $0 Plan 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. Medicare Advantage also pays for any amounts after Medicare criteria is met, for up to 365 visits per year. You pay: $0 except for cost of visits not covered by the plan |
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: $0 Plan pays: 100% of Medicare-covered hospital stay each time you are admitted. Stays after Medicare day limit, paid as medically necessary. No day limit. Medicare permits inpatient stays for up to 90 days each Benefit Period. Once in a lifetime you may qualify for an additional 60 days (up to 150). These are called your lifetime reserve days. 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: $0 Plan pays: After Part B deductible, 100% 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: $0 Plan pays: Part B deductible and 100% 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: $0 Plan pays: 100% for Medicare-covered care, up to 100 days. Beyond 100 days, 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: $0 Plan pays: Part B deductible and 100% 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.
2When you select Medicare Advantage, UnitedHealthcare (UHC) becomes your primary insurer for all Part A and Part B related claims. Allowable benefits are paid for by UHC and not Medicare.
3Medicare Plus pays only for services that Medicare covers. You pay the full cost of any non-covered services.