Page 73 - Cover letter and evaluation for Michele Buros
P. 73
Your Medicare Health Plan Details https://www.medicare.gov/find-a-plan/results/planresults/plan-details.as...
Outpatient hospital coverage
In-Network: $25-195 per visit
Out-of-Network: 20% per visit
Doctor visits Primary:
In-Network: $5 per visit
Out-of-Network: 20% per visit
Specialist:
In-Network: $25 per visit
Out-of-Network: 20% per visit
Preventive care
In-Network: $0 copay
Out-of-Network: 0-20%
Emergency care/Urgent care Emergency: $80 per visit (always covered)
Urgent care: $5-50 per visit (always covered)
Diagnostic procedures/lab Diagnostic tests and procedures:
services/imaging In-Network: $0 copay
Out-of-Network: 20%
Lab services:
In-Network: $0 copay
Out-of-Network: 20%
Diagnostic radiology services (e.g., MRI):
In-Network: $200
Out-of-Network: 20%
Outpatient x-rays:
In-Network: $15
Out-of-Network: 20%
Mental health services
In-Network: $1,590 per stay
Out-of-Network: 20% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network: $40
Out-of-Network: 20%
Outpatient individual therapy visit with a psychiatrist:
In-Network: $40
Out-of-Network: 20%
Outpatient group therapy visit:
In-Network: $40
Out-of-Network: 20%
Outpatient individual therapy visit:
In-Network: $40
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: 20% per stay
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