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Medicare's Part A and B with Plan 65 Benefit Plan K

Medicare Part A (Hospital Services) Medicare Part A Plan 65 Benefit Plan K
Per benefit period* – A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row. Medicare Part A Pays Plan 65 Benefit Plan K Pays You Pay
Hospitalization* Semi-private room and board, general nursing and miscellaneous services and supplies.
First 60 days All but $1,216 $608 $608 (50% Part A deductible)
61st through 90th day All but $304 a day $304 a day $0
91st day and after:      
• while using 60 lifetime reserve days All but $608 a day $608 a day $0
• once lifetime reserve days are used:
- additional 365 days
$0 100% of Medicare eligible expenses $0**
- beyond the additional 365 days $0 $0 All costs
Skilled Nursing Facility Care* You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.
First 20 days All approved amounts $0 $0
21st through 100th day All but $152 a day Up to $76 a day Up to $76 a day
101st day and after $0 $0 All costs
Blood
First 3 pints (per calendar year under Parts A or B) $0 50% 50%
Additional amounts 100% $0 $0
Hospice Care Available as long as your doctor certifies you are terminally ill and you elect to receive these services. All but limited coinsurance for outpatient drugs & inpatient respite care 50% of Medicare copayment/ coinsurance 50% of Medicare copayment/ coinsurance
Medicare Part B (Medical Services) Medicare Part B Plan 65 Benefit Plan K
Calendar Year* - Once you have been billed $147 of Medicare-approved amounts for covered service (which are noted with asterisks), your Part B deductible will have been met for the calendar year. Medicare Part B Pays Plan 65 Benefit Plan K Pays You Pay
Medical Expenses In or out of the hospital treatment, such as physician's services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment.
First $147 of Medicare-approved amounts* $0 $0 $147 (Part B deductible)
Preventive Benefits for Medicare covered services 75% or more of Medicare approved amounts Remainder of Medicare approved amounts All costs above Medicare approved amounts
Remainder of Medicare-approved amounts Generally 80% Generally 10% Generally 10%
Part B Excess Charges (Above Medicare Approved Amounts) $0 $0 All costs and they do not count toward annual out-of-pocket limit
Blood
First 3 pints (per calendar year under Parts A or B) $0 50% 50%
Next $147 of Medicare-approved amounts* $0 $0 $147 (Part B deductible)
Remainder of Medicare-approved amounts Generally 80% Generally 10% Generally 10%
Clinical Laboratory Services
Tests for diagnostic services 100% $0 $0
Medicare Parts A & B
Home Health Care
Medicare-approved services:
• Medically necessary skilled care services & medical supplies 100% $0 $0
• Durable medical equipment
- First $147 of Medicare-approved amounts*
$0 $0 $147 (Part B deductible)
- Remainder of Medicare-approved amounts 80% 10% 10%
Other Benefits
Foreign Travel (not covered by Medicare) Medically necessary emergency care services during the first 60 days of each trip outside USA.
First $250 each calendar year $0 You will pay half of the cost-sharing of some covered services until the annual out-of-pocket is reached. The amounts that count toward your limit are noted with diamonds (♦) above.
Remainder of charges $0

**Notice: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.