Immunizations Covered Medicare Part B services include: There is no coinsurance, copayment, or deductible Pneumonia vaccine for the pneumonia, Flu shots, once a year in the fall or winter influenza, and Hepatitis B Hepatitis B vaccine if you are at high or intermediate risk of vaccines. getting Hepatitis B Other vaccines if you are at risk and they meet Medicare Part B coverage rules We also cover some vaccines under our Part D prescription drug benefit. Inpatient hospital care You pay a $1316 Includes inpatient acute, inpatient rehabilitation, long-term care deductible for days 1-60. hospitals and other types of inpatient hospital services. Inpatient hospital care starts the day you are formally admitted to the You pay a $329 copay per hospital with a order. The day before you are doctor’s day for days 61-90. discharged is your last inpatient day. Our plan covers 90 days for an inpatient hospital stay. You pay $658 copay per Our plan covers 60 lifetime reserve days. lifetime reserve Covered services include but are not limited to: Semi-private room (or a private room if medically These are 2017 amounts necessary) which may change for Meals including special diets 2018. Regular nursing services Costs of special care units (such as intensive care or Cost shares are applied coronary care units) starting on the first day of Drugs and medications admission and do not Lab tests include the date of X-rays and other radiology services discharge. Necessary surgical and medical supplies Use of appliances, such as wheelchairs Operating and recovery room costs Physical, occupational, and speech language therapy Inpatient substance abuse services
Immunizations Covered Medicare Part B services include: Pneumonia vaccine Flu shots, once a year in the fall or winter Hepatitis B vaccine if you are at high or intermediate risk of getting Hepatitis B Other vaccines if you are at risk and they meet Medicare Part B coverage rules We also cover some vaccines under our Part D prescription drug benefit. There is no coinsurance, copayment, or deductible for the pneumonia, influenza, and Hepatitis B vaccines. Inpatient hospital care Includes inpatient acute, inpatient rehabilitation, long-term care hospitals and other types of inpatient hospital services. Inpatient hospital care starts the day you are formally admitted to the hospital with a doctor’s order. The day before you are discharged is your last inpatient day. Our plan covers 90 days for an inpatient hospital stay. Our plan covers 60 lifetime reserve days. Covered services include but are not limited to: Semi-private room (or a private room if medically necessary) Meals including special diets Regular nursing services Costs of special care units (such as intensive care or coronary care units) Drugs and medications Lab tests X-rays and other radiology services Necessary surgical and medical supplies Use of appliances, such as wheelchairs Operating and recovery room costs Physical, occupational, and speech language therapy Inpatient substance abuse services You pay a $1316 deductible for days 1-60. You pay a $329 copay per day for days 61-90. You pay $658 copay per lifetime reserve These are 2017 amounts which may change for 2018. Cost shares are applied starting on the first day of admission and do not include the date of discharge.
H4093_ISNP_HMO_NONPOS_Model_wRx_v2-PA_EOC.docx