admissions in a admissions in a admissions in a 25 Inpatient Inpatient Inpatient general or mental general or mental general or mental Full semiprivate The Part A Nothing through hospital: hospital: hospital: benefits less the Part A for day 160 and the 365th day per deductible benefit for day 160 and Part A for day then all charges deductible coinsurance period; Part A for day 6190 per the coinsurance benefit period; 6190 per and Part A for any benefit period; coinsurance full semiprivate benefits lifetime reserve Medicare less the Part A days used; then after coinsurance for 60 lifetime days are used up, Medicare Medicare reserve days (Benefits in a full semiprivate benefits mental are limited through the 365th day per hospital to 190 days per lifetime) benefit period and and and 25 Inpatient physician Inpatient physician Inpatient Physician covered professional other covered professional other covered professional mental health provider mental health provider mental health provider services: Full benefits less services: The Part B services: Nothing for as the Part B and and Part B many days as are deductible deductible medically Part B for as (full benefits coinsurance coinsurance necessary many days as are when covered by Medex medically only) for as many days as necessary are medically necessary Full The treatment: treatment: treatment: 25 Outpatient Outpatient Outpatient benefits less the Part B Part B and Nothing for as many visits deductible and Part B Part B (full as are deductible coinsurance medically necessary (Nothing for benefits when covered by coinsurance services not covered by Medex only) for as many visits as are Medicare) medically necessary *Benefits for are provided on the You may have to pay covered services allowed charge. any amount over the (See Parts 2 and 9.) allowed charge. ***Treatment for rape-related mental or emotional conditions is covered to the same extent as biologically-based mental or nervous conditions. Mental Health Treatment for Non-Biologically-Based Mental or Nervous not included in above section (includes drug addiction and alcoholism) Conditions
Inpatient admissions in a general or mental hospital: Full semiprivate benefits less the Part A deductible for day 160 and Part A coinsurance for day 6190 per benefit period; and full semiprivate benefits less the Part A coinsurance for 60 Medicare lifetime reserve days (Benefits in a mental hospital are limited to 190 days per lifetime) Inpatient admissions in a general or mental hospital: The Part A deductible for day 160 and Part A coinsurance for day 6190 per benefit period; the Part A coinsurance for any Medicare lifetime reserve days used; then after Medicare days are used up, full semiprivate benefits through the 365th day per benefit period Inpatient admissions in a general or mental hospital: Nothing through the 365th day per benefit period; then all charges 25 Inpatient physician and covered professional mental health provider services: Full benefits less the Part B deductible and Part B coinsurance for as many days as are medically necessary Inpatient physician and other covered professional mental health provider services: The Part B deductible and Part B coinsurance (full benefits when covered by Medex only) for as many days as are medically necessary Inpatient Physician and other covered professional mental health provider services: Nothing for as many days as are medically necessary 25 Outpatient treatment: Full benefits less the Part B deductible and Part B coinsurance (Nothing for services not covered by Medicare) Outpatient treatment: The Part B deductible and Part B coinsurance (full benefits when covered by Medex only) for as many visits as are medically necessary Outpatient treatment: Nothing for as many visits as are medically necessary 25 *Benefits for covered services are provided on the allowed charge. You may have to pay any amount over the allowed charge. (See Parts 2 and 9.) ***Treatment for rape-related mental or emotional conditions is covered to the same extent as biologically-based mental or nervous conditions. Mental Health Treatment for Non-Biologically-Based Mental or Nervous Conditions not included in above section (includes drug addiction and alcoholism)
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