HEARING - U.S. Senate Special Committee on Aging

197
MEDICARE (PART Ay. HOSPITAL INSURANCE - COVERED
SERVICES PER BENEFIT PERIOD(1)
SERVICE BENEFrT YEtICARE PAYS" YOU PAY"
HOSPITALIZATION ... Fist 60 days Al but $520 $S20
Semiprivate room and board.
general ursirngr and m ous 61st to 90th day Al but 5130 a day $130 a day
hospital services and saftPles. gist to 150th day Al but $260 a day $260 a day
Beyond 150 days Noting Al costs
POSTHOSPITAL SKILLED F¢rt 20 days 1001 o approved
NURSING FACILITY CARE ... Ina F-tdas l0oapredNo"thin
facrlity approved by Medicare. You W t
must have been in a hospftal for
at least 3 days ontr the Additional 80 days AD but SSS a day $65 a day
facbty wtthin 30 days after hospita Be yond 100 days Nothing AN costs
dischargel. (2
HOME HEALTH CARE Visits limited to Full cost NO"tg
medical necessity
HOSPICE
HOS~~~~~~iCE
CARE
CAnREe Tswo 90oay is Al
t-aypefo or
but
outpatient
limited costs
drugs
e
froutpatient
ted cost sharing
drugs
and 30day oe Priodand Wipatient respite care and inparien
BLOOD _ ood Ar but ftst 3 pints For first 3 pints
S60 Reserve Days may be used only once: days used are not renewable.
*These figures are for 1987 and are subject to change each year.
(1) A Benefit Period begins on the frst day you receive service as an ipatient in a hospital and ends after
you have been out of thne hospital or skitied nursing taclilty for 60 days in a row.
(2) Medicare and private insurance wia not pay for most nurfing home care. You pay for custodral care and
mtost care In a nursing home.
MEDICARE (PART B): MEDICAL INSURANCE - COVERED
SERVICES PER CALENDAR YEAR
SERVICE BENEFtT MEDICARE PAYS YOU PAY
Medicare pays for medical
services in or out
MEDICAL EXPENSE ot hospital. Some Insur-
Physicia ns servbes. Inpatient and ance policies pay less
outpatient redical services and (or noftig) for hospi
supplies. physical and speech tai outpatient medcal
therapy. animtyance, ate. services or services
8% of
approved amount
(after $75 deductibte)
$75 deductible
ps 20%
of balance
of approved amount
(plus any charge
above approved
HOME ~Visits HEAL~~~h
CARE
HOME HEALTH CARE _
in a doctor's office
kyilmtd to
_medical ncessty Funj cost
armoKnt)-
Notlvng
OUTPATIENT HOSPiTAL
OUTPATIENT HOSPITAL Uramted
Unterted as80%
a approved
of
amnt
Subplct
plus 20%
to
of
deductible
balance
TREATMENT medically necessary (after $75 derductible) of approved amount.
80% of approved amount For first 3 pints plus
BLOOD iE40d (after BLOOD(astarting
$75 with deductible 4th pint) and 20% approved of amane amountof
(after $75 deductible)
sn7B any further you -at covered -a services 41a o1 exPwse you racerve -o the xwvu,_ rest of r~ the year. m lY me r ar ff c iwe ooes "Di ait'y To
"YOU PAY FOR charges higthr than amount approved by Medicare uiaess the doctor or supplier agrees to
accept Medicare s approved amount as the total charge for services rendered. (See page 5.1
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