Inpatient hospital stays For each Medicare For each Medicare covered stay: covered stay: Includes inpatient acute, inpatient rehabilitation, long-term care Days 1- 60 Days 1- 60: hospitals and other types of $1316 deductible $1316 deductible inpatient hospital services. Inpatient hospital care starts the Days 61-90 Days 61-90 day you are formally admitted to $329 co-pay per day $329 co-pay per day the hospital with a order. doctor’s The day before you are discharged Days 91 and beyond: Days 91 and beyond: is your last inpatient day. $658 per lifetime reserve $658 per lifetime reserve day day These are 2017 amounts which may change for 2018. Part D prescription drug Deductible: $400 Deductible: $405 coverage Coinsurance during the Coinsurance during the (See Section 1.6 for details.) Initial Coverage Stage: Initial Coverage Stage: Drug Tier 1: 25% Drug Tier 1: 25% Annual Notice of Changes for 2018 Table of Contents Summary of Important Costs for 2018 1 SECTION 1 Changes to Benefits and Costs for Next Year 4 Section 1.1 Changes to the Monthly Premium 4 – Section 1.2 Changes to Your Maximum Out-of-Pocket Amount 4 – Section 1.3 Changes to the Provider Network 4 – Section 1.4 Changes to the Pharmacy Network 5 – Section 1.5 Changes to Benefits and Costs for Medical Services 5 – Section 1.6 Changes to Part D Prescription Drug Coverage 7 –
Inpatient hospital stays 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. For each Medicare covered stay: Days 1- 60 $1316 deductible Days 61-90 $329 co-pay per day Days 91 and beyond: $658 per lifetime reserve day For each Medicare covered stay: Days 1- 60: $1316 deductible Days 61-90 $329 co-pay per day Days 91 and beyond: $658 per lifetime reserve day These are 2017 amounts which may change for 2018. Part D prescription drug coverage (See Section 1.6 for details.) Deductible: $400 Coinsurance during the Initial Coverage Stage: Drug Tier 1: 25% Deductible: $405 Coinsurance during the Initial Coverage Stage: Drug Tier 1: 25% Annual Notice of Changes for 2018 Table of Contents Summary of Important Costs for 2018 1 SECTION 1 Changes to Benefits and Costs for Next Year 4 Section 1.1 – Changes to the Monthly Premium 4 Section 1.2 – Changes to Your Maximum Out-of-Pocket Amount 4 Section 1.3 – Changes to the Provider Network 4 Section 1.4 – Changes to the Pharmacy Network 5 Section 1.5 – Changes to Benefits and Costs for Medical Services 5 Section 1.6 – Changes to Part D Prescription Drug Coverage 7
H8067_ISNP_HMO_NONPOS_Model_wRx_v2-MD_EOC.docx