Page 34 - Cover letter and evaluation for Michele Buros
P. 34
Your Medicare Health Plan Details https://www.medicare.gov/find-a-plan/results/planresults/plan-details.as...
Skilled Nursing Facility
In-Network: $0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network: 30% per stay
Rehabilitation services Occupational therapy visit:
In-Network: $40
Out-of-Network: 30%
Physical therapy and speech and language therapy visit:
In-Network: $40
Out-of-Network: 30%
Ambulance
In-Network: $350
Out-of-Network: $350 or 30%
Transportation
In-Network: $10
Out-of-Network: 50%
Foot care (podiatry services) Foot exams and treatment:
In-Network: $40
Out-of-Network: 30%
Routine foot care:
In-Network: $40
Out-of-Network: 30%
Medical equipment/supplies Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network: 20% per item
Out-of-Network: 30% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network: 20% per item
Out-of-Network: 30% per item
Diabetes supplies:
In-Network: 0-20% per item
Out-of-Network: 30% per item
Wellness programs (e.g., fitness, Covered
nursing hotline)
Medicare Part B drugs Chemotherapy:
In-Network: 20%
Out-of-Network: 30%
Other Part B drugs:
In-Network: 20%
Out-of-Network: 30%
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Benefits Services
Hearing
Hearing exam In-Network: $40
Out-of-Network: 30%
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