Page 33 - Cover letter and evaluation for Michele Buros
P. 33
Your Medicare Health Plan Details https://www.medicare.gov/find-a-plan/results/planresults/plan-details.as...
Outpatient hospital coverage
In-Network: $350 per visit
Out-of-Network: $450 per visit
Doctor visits Primary:
In-Network: $0 copay
Out-of-Network: $25 per visit
Specialist:
In-Network: $40 per visit
Out-of-Network: $60 per visit
Preventive care
In-Network: $0 copay
Out-of-Network: $0 copay
Emergency care/Urgent care Emergency: $80 per visit (always covered)
Urgent care: $50 per visit (always covered)
Diagnostic procedures/lab Diagnostic tests and procedures:
services/imaging In-Network: $0-25
Out-of-Network: $35
Lab services:
In-Network: $0-25
Out-of-Network: $35
Diagnostic radiology services (e.g., MRI):
In-Network: $270
Out-of-Network: $370
Outpatient x-rays:
In-Network: $50
Out-of-Network: $70
Mental health services
In-Network: $275 for days 1 through 5
$0 for days 6 through 90
Out-of-Network: $375 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
In-Network: $40
Out-of-Network: 30%
Outpatient individual therapy visit with a psychiatrist:
In-Network: $40
Out-of-Network: 30%
Outpatient group therapy visit:
In-Network: $40
Out-of-Network: 30%
Outpatient individual therapy visit:
In-Network: $40
Out-of-Network: 30%
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