Page 61 - Cover letter and evaluation for Michele Buros
P. 61
Your Medicare Health Plan Details https://www.medicare.gov/find-a-plan/results/planresults/plan-details.as...
Mental health services
In-Network: $530 for days 1 through 3
$0 for days 4 through 90
Out-of-Network: $530 for days 1 through 3
$0 for days 4 through 90
Outpatient group therapy visit with a psychiatrist:
In-Network: 20%
Out-of-Network: 20%
Outpatient individual therapy visit with a psychiatrist:
In-Network: 20%
Out-of-Network: 20%
Outpatient group therapy visit:
In-Network: 20%
Out-of-Network: 20%
Outpatient individual therapy visit:
In-Network: 20%
Out-of-Network: 20%
Skilled Nursing Facility
In-Network: $0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network: $0 for days 1 through 20
$167.50 for days 21 through 100
Rehabilitation services Occupational therapy visit:
In-Network: 20%
Out-of-Network: 20%
Physical therapy and speech and language therapy visit:
In-Network: 20%
Out-of-Network: 20%
Ambulance
In-Network: 20%
Out-of-Network: 20%
Transportation Not covered
Foot care (podiatry services) Foot exams and treatment:
In-Network: 20%
Out-of-Network: 20%
Routine foot care: Not covered
Medical equipment/supplies Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network: 18% per item
Out-of-Network: 18% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network: 20% per item
Out-of-Network: 20% per item
Diabetes supplies:
In-Network: $0 or 20% per item
Out-of-Network: $0 or 20% per item
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