![]() If you have met the $500 OOPL per participant, 100% Plan pays: If you have not met the $500 OOPL per participant, 80% Plan pays: Part B deductible and 20% coinsurance You pay: 20% up to $500 OOPL per participant, after OOPL, $0 If you have met the Part B deductible, and also the $500 OOPL per participant, 20% If you have met the Part B deductible, but you have not met the $500 OOPL per participant, 0% Plan pays: If you have not met the Part B deductible, 20% Medicare pays: After Part B deductible, 80% ![]() You pay: 100% of costs exceeding plan payment of $1,000ĭurable Medical Equipment (including Durable Diabetic Equipment and Related Supplies) and Other Medical Supplies You pay: 100% of costs exceeding plan payment of $1,000 For Part B deductible and 20% coinsuranceĪnnual Medical Out-of-Pocket Limit (OOPL)Įxcept for up to $500 per individual for durable medical equipment as listed below Plan Pays: For Part A, varying amounts as listed below for hospital and skilled nursing facility care. For Part B deductible and 20% coinsurance Plan pays: For Part A, varying amounts as listed below for hospital and skilled nursing facility care. Medicare pays: For Part A, varying coinsurance as listed below for hospital inpatient and skilled nursing facility care. Plan pays: Part A inpatient hospital deductible of $1,600 and Part B deductible of $226 Medicare pays: Allowable services after Part A ($1,600) and Part B ($226) deductibles
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