Page 47 - APPENDICES for Diane Falten
P. 47
PART B DRUGS
These are drugs you usually get at a doctor's o ce or hospital outpatient setting, like the u shot,
chemotherapy, or other shots.
Chemotherapy drugs In-network: 20% coinsurance Limits apply
Out-of-network: 20%
coinsurance
Other Part B drugs In-network: 20% coinsurance Limits apply
Out-of-network: 20%
coinsurance
Extra bene ts
HEARING
Hearing exam In-network: $40 copay Limits apply
Out-of-network: $55 copay
Fitting/evaluation In-network: $0 copay Limits apply
Hearing aids - all types In-network: $495-2,095 Limits apply
copay
