Page 60 - Cover letter and evaluation for Michele Buros
P. 60
Your Medicare Health Plan Details https://www.medicare.gov/find-a-plan/results/planresults/plan-details.as...
Inpatient hospital coverage
In-Network: $600 for days 1 through 3
$0 for days 4 through 90
$0 for days 91 and beyond
Out-of-Network: $600 for days 1 through 3
$0 for days 4 through 90
Outpatient hospital coverage
In-Network: 20% per visit
Out-of-Network: 20% per visit
Doctor visits Primary:
In-Network: 20% per visit
Out-of-Network: 20% per visit
Specialist:
In-Network: 20% per visit
Out-of-Network: 20% 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: 20% per visit (always covered)
Diagnostic procedures/lab Diagnostic tests and procedures:
services/imaging In-Network: $0 or 20%
Out-of-Network: 20%
Lab services:
In-Network: $0 or 20%
Out-of-Network: $0 or 20%
Diagnostic radiology services (e.g., MRI):
In-Network: 20%
Out-of-Network: 20%
Outpatient x-rays:
In-Network: 20%
Out-of-Network: 20%
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