Medicare Select is Unity’s Medicare supplement plan. Medicare Select is an HMO plan that covers the remaining costs that Medicare doesn’t cover. This is an individual plan. If you and your spouse both want supplemental coverage you need to purchase two policies. In order to apply for Medicare Select, you need to be enrolled in Medicare Part A and Medicare Part B.
Here’s some key information about Medicare Select:
If you go to see your primary care physician, Medicare Part B pays 80% of the charges after your $162 deductible. Medicare Select pays the $162 deductible and 20% of the Medicare approved charges. The amount you have to pay for the service is $0.
|
|
Medicare Part B Pays |
Medicare Select Pays |
You Pay |
|---|---|---|---|
| PCP office visit | 80% of Medicare approved charges after $140 deductible | $140 deductible and 20% of Medicare approved charges | $0 |
(For complete details, see the Medicare Select 2012 Outline of Coverage)
|
Services |
Medicare Pays |
Medicare Select Pays |
|---|---|---|
| Part A Deductible ($1,156) | $0 | $1,156 |
| Hospitalization (Inpatient) Semi-private room and board; general nursing and misc. hospital services and supplies. Includes meals, special care units, lab tests, prescription drugs, diagnostic x-rays, medical supplies, operation and recovery room, anesthesia and rehabilitation services. |
• Day 1-60: All but $1,156 deductible per Benefit Period |
• Day 1-60: $1,156 deductible per benefit period • Day 61-90: $289 per day • Day 91-150: $578 per day • Day 151 and beyond: 100% of Part A-eligible charges when Medicare days are exhausted |
| Skilled Nursing Care (Inpatient)
Confinement must meet Medicare standards. You must have been in a hospital for at least three (3) days and enter the facility within 30 days after discharge. |
• Day 1-20: 100% of the cost (after a three (3) day period of hospital confinement) per Benefit Period • Day 21-100: All but $144.50 per day per Benefit Period • Day 101 and beyond: $0 per Benefit Period |
• Day 1-20: $0 • Day 21-100: $144.50 per day • Day 101 and beyond: No coverage; see below. |
| Other Skilled Nursing Care (Inpatient) Catastrophic coverage for 30 days. Must be skilled care but does not have to be covered by Medicare. |
No coverage | 30 days at 100% per Benefit Period. Must meet Unity skilled care guidelines. |
| Hospice Care Available only to the terminally ill. |
All but limited costs for outpatient drugs and inpatient respite care | Medicare eligible expenses (except for drugs which are covered under Part D) |
|
Psychiatric/Mental Health Care (Inpatient) |
190 days per lifetime. | 175 days per lifetime after Medicare days are exhausted. |
| Blood (Inpatient) | All but the first three (3) pints of blood. | The first three (3) pints of blood. |
| Kidney Disease Treatment (Inpatient and Outpatient) Dialysis, transplant and donor related services. |
Limited. | Up to $30,000 annually. This policy will not duplicate other coverage. |
| Home Health Care | 100% of Medicare Approved Home Health Care. | 365 Home Health visits in addition to those covered by Medicare. |
|
Services |
Medicare Pays
|
Medicare Select Pays |
|---|---|---|
| Part B Deductible ($140) | $0 | $140 |
| Part B eligible expenses for physicians’ services, in- and outpatient medical services, physical and speech therapy, diagnostic tests and durable medical equipment. | After the $140 deductible, generally 80% of Medicare approved charges | $140 deductible and 20% of Medicare approved charges with no lifetime maximum. |
| Blood | 80% of approved amount (after $140 deductible, starting with the fourth pint) | First 3 pints; then 20% of approved amount (after $140 deductible) |
| Chiropractic | 80% of costs for manipulation of the spine to correct subluxation when provided by a chiropractor or other qualified professional. | 20% of Medicare approved charges and 100% of medically necessary non-Medicare approved charges when received from a participating chiropractor. |
| Immunizations | Flu and Pneumococcal Pneumonia covered at 100%; Hepatitis B shot covered at 80% for those at medium to high risk. | 20% of Medicare approved charges. |
| Mental Health & Substance Abuse | 60% of outpatient mental health care services when furnished by a doctor, clinical psychologist, clinical social worker, clinical nurse specialist or physician’s assistant in an office setting, clinic or hospital outpatient department. Medicare covers substance abuse treatment in an outpatient treatment center that is certified by Medicare. | 40% of Medicare approved charges. |
| Emergency Room | Medicare covers 80% of Medicare approved charges after the deductible. | 20% of Medicare approved charges received in the USA. (See the Foreign Travel benefit for services outside the USA.) |
| Breast Reconstruction | Limited. | Covers non-Medicare breast reconstruction of the affected tissue incident to a mastectomy. |
| Foreign Travel | Not covered. | 80% up to lifetime limit of $50,000 for medically necessary hospital services and supplies as a result of an injury or illness of sudden and unexpected onset during the first 60 days of a trip after a $250 separate deductible is satisfied. Follow-up care must be provided in the United States. |
| Routine Physical Exam | Not covered. | One routine exam per calendar year is covered at 100% |
| Routine Eye Exam & Refraction | Not covered. | One routine exam per calendar year is covered at 100% |
| Routine Hearing Exam | Not covered. | One routine exam per calendar year is covered at 100% |
| Other Routine Care | Not covered. | Covered at 100%. |
| Diabetic Supplies | Medicare pays 80% after the Part B deductible. Part B covers some blood glucose test strips, blood glucose monitor, lancet devices and lancets, glucose control solutions for checking test strip accuracy and monitors. | Part B deductible, then 20% of Medicare approved charges. |
| Diabetic Insulin, Syringes and Needles | Insulin, syringes and needles are covered under Medicare Part D. | Not covered (covered by Part D). |
Unity Health Plans Insurance Corporation and its representatives are not connected with Medicare. This is an advertisement for health insurance through Unity Health Plans Insurance Corporation.
