What you will pay

Monthly cost (premium): $166 - $1,318

Hospital (Part A) deductible: $0

Medical (Part B) deductible: $283

Part B copays/coinsurance: $0 Generally your cost for approved Part B services

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Covered services

What you will pay for Part A services

Hospital stays

• Days 1-60: $0

• Days 61-90: $0

• Days 91-150: $0 while using your 60 lifetime reserve days

• Additional 365 days: $0 for Medicare-eligible services

• After the additional 365 days: All costs

 

Skilled nursing facility (for Medicare-covered stays)

• Day 1-20: $0

• Days 21-100: $0

• After 100 days: All costs

 

Blood (during a hospital stay)

• First 3 pints: $0

• After 3 pints: $0

 

Hospice care: $0

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What you will pay for 

Part A & B services

Home health care (for Medicare-approved services): $0

Durable medical equipment (covered by Medicare)

• First: $283 (Part B deductible) 

• Then: $0

 

What you will pay for Part B services

Covered Part B services

• First: $283 (Part B deductible) 

• Then: $0

 

Preventive services: $0 Generally, for most preventive services, Medicare covers

Part B excess charges: $0

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Blood (outside a hospital stay)

• First 3 pints: $0

• After 3 pints: $283 (Part B deductible), then $0

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Tests for diagnostic services: $0

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Extra benefits - not covered by Medicare

Foreign travel emergency

• First: $250

• Then: 20% and amounts over the $50,000 lifetime maximum

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