SERVICE | COST |
Inpatient hospital coverage | $0 or $8 per stay
|
Outpatient hospital coverage | $0 or $2 per visit
|
Doctor visits | Primary: $0 copay Specialist: $0 or $0-2 per visit
|
Preventive care | $0 copay
|
Emergency care/Urgent care | Emergency: $0 copay Urgent care: $0 copay
|
Diagnostic procedures/lab services/imaging | Diagnostic tests and procedures: $0 or $0-1.50 Lab services: $0 or $0-1.50 Diagnostic radiology services (e.g., MRI): $0 or $0-2 Outpatient x-rays: $0 or $0-1.50
|
Mental health services | $0 or $8 per stay Outpatient group therapy visit with a psychiatrist: $0 or $2 Outpatient individual therapy visit with a psychiatrist: $0 or $2 Outpatient group therapy visit: $0 or $2 Outpatient individual therapy visit: $0 or $2
|
Skilled Nursing Facility | $0 copay
|
Rehabilitation services | Occupational therapy visit: $0 or $2 Physical therapy and speech and language therapy visit: $0 or $0-2
|
Ambulance | $0 copay
|
Transportation | Not covered
|
Foot care (podiatry services) | Foot exams and treatment: $0 or $0-2 Routine foot care: $0 copay
|
Medical equipment/supplies | Durable medical equipment (e.g., wheelchairs, oxygen): 0% or 0-20% per item Prosthetics (e.g., braces, artificial limbs): 0% or 0-20% per item Diabetes supplies: $0 copay
|
Wellness programs (e.g., fitness, nursing hotline) | Covered
|
Medicare Part B drugs | Chemotherapy: $0 copay Other Part B drugs: $0 copay
|