you join Medicare Annual 100% for all Preventive 100% for all Part B, then you Wellness preventive services Services preventive services are eligible as every covered under covered Original follows; during the 12 months. Original Medicare at Medicare at zero cost first 12 months of zero cost sharing. sharing. your new Part B 100% for all coverage, you can Any additional – preventive services Any additional Welcome get either a preventive services covered under preventive services to Welcome to approved by Original Medicare. approved by Medicare Medicare Medicare mid-year Medicare mid-year Preventive Visits or will be covered by Any additional will be covered by Visits an Annual the plan or by preventive services the plan or by (initial Wellness Original Medicare. approved by Original Medicare. Visit. After your Medicare mid-year first Plan covers a will be covered by Plan covers a physical 12 months, you physical exam Original Medicare. physical exam exam). can get one annually. annually. When Hospital Inpatient care at 100% after the 100% after $200 100% after $200 Services network hospitals following amounts copayment per copayment per (semiprivate for each benefit day (days 1-5) day (days 1-5) room, ancillary period per per services, - $1,184 deductible admission; 100% admission; 100% physician visits) for days 1-60; $296 after day 5 (1) after day 5 (1) copayment per day (days 61-90); $592 copayment per lifetime reserve day (days 91- Outpatient 80% after $147 90%-100% (based on 90%-100% on 150) (2) services deductible services received) services received) nonsurgical Outpatient surgical after 80% $147 90% 90% services deductible Emergency care per visit after per visit after 80% $147 100% 100% (emergency room, deductible and $65 copayment $65 copayment emergency services) emergency room (waived if admitted (waived if admitted copayment (waived if within 24 within 24 hours) admitted to hospital within 3 days of emergency room visit) Additional Ambulatory surgical 80% $147 90% 90% Medical center deductible Services Immediate care after per visit after per after 80% $147 100% 100% facility deductible $25 copayment $25 copayment
Preventive Services – Welcome to Medicare Visits (initial physical exam). When you join Medicare Part B, then you are eligible as follows; during the first 12 months of your new Part B coverage, you can get either a Welcome to Medicare Preventive Visits or an Annual Wellness Visit. After your first 12 months, you can get one Annual Wellness every 12 months. 100% for all preventive services covered under Original Medicare. Any additional preventive services approved by Medicare mid-year will be covered by Original Medicare. 100% for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare. Plan covers a physical exam annually. 100% for all preventive services covered Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare. Plan covers a physical exam annually. Hospital Services Inpatient care at network hospitals (semiprivate room, ancillary services, physician visits) 100% after the following amounts for each benefit period - $1,184 deductible for days 1-60; $296 copayment per day (days 61-90); $592 copayment per lifetime reserve day (days 91- 150) (2) 100% after $200 copayment per day (days 1-5) per admission; 100% after day 5 (1) 100% after $200 copayment per day (days 1-5) per admission; 100% after day 5 (1) Outpatient nonsurgical 80% after $147 90%-100% (based on 90%-100% on services deductible services received) services received) Outpatient surgical 80% after $147 90% 90% services deductible Emergency care 80% $147 100% per visit after 100% per visit after (emergency room, deductible and $65 copayment $65 copayment emergency services) emergency room (waived if admitted (waived if admitted copayment (waived if within 24 within 24 hours) admitted to hospital within 3 days of emergency room visit) Additional Ambulatory surgical 80% $147 90% 90% Medical center deductible Services Immediate care 80% after $147 100% per visit after 100% per after facility deductible $25 copayment $25 copayment
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