SERVICE | COST |
Inpatient hospital coverage | $0 copay
|
Outpatient hospital coverage | $0 copay
|
Doctor visits | Primary: $0 copay Specialist: $10 per visit
|
Preventive care | $0 copay
|
Emergency care/Urgent care | Emergency: $65 per visit (always covered) Urgent care: $0-65 per visit (always covered)
|
Diagnostic procedures/lab services/imaging | Diagnostic tests and procedures: $0 copay Lab services: $0 copay Diagnostic radiology services (e.g., MRI): 10% Outpatient x-rays: 10%
|
Mental health services | $0 copay Outpatient group therapy visit with a psychiatrist: $10 Outpatient individual therapy visit with a psychiatrist: $10 Outpatient group therapy visit: $10 Outpatient individual therapy visit: $10
|
Skilled Nursing Facility | $0 copay
|
Rehabilitation services | Occupational therapy visit: $5 Physical therapy and speech and language therapy visit: $5
|
Ambulance | $0 copay
|
Transportation | $0 copay
|
Foot care (podiatry services) | Foot exams and treatment: $5 Routine foot care: Not covered
|
Medical equipment/supplies | Durable medical equipment (e.g., wheelchairs, oxygen): 0-20% per item Prosthetics (e.g., braces, artificial limbs): 20% per item Diabetes supplies: $0 copay
|
Wellness programs (e.g., fitness, nursing hotline) | Covered
|
Medicare Part B drugs | Chemotherapy: 20% Other Part B drugs: 20%
|