CommunityCare65

CommunityCare65

PLAN C

MEDICARE (PART A) - HOSPITAL SERVICES - PER BENEFIT PERIOD

* A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facility for 60 days in a row.

Click here to view the premiums for this plan

CommunityCare65 Plan C Benefit Summary
Services Medicare Pays Plan C Pays You Pay
Hospitalization* Semiprivate room and board, general nursing, miscellaneous services and supplies
First 60 days All but $1,100 $1,100
(Part A deductible) 		$0
61st through 90th day All but $275 a day $275 a day $0
91st day and after      
- While using 60 lifetime reserve days All but $550 a day $550 a day $0
- Once lifetime reserve days are used:
- Additional 365 days		 $0 100% of Medicare Eligible Expenses $0
- Beyond the additional 365 days $0 $0 All Costs
 
Skilled Nursing Facility Care  *  You must meet Medicare's requirements, including having been in a hospital for at least 3 days and entered a Medicare-approved facility within 30 days after leaving the hospital.
First 20 days All approved amounts $0 $0
21st through 100th day All but $137.50 a day Up to $137.50 a day $0
101st day and after $0 $0 All Costs
 
Blood
First 3 pints $0 All Costs $0
Additional amounts 100% $0 $0
 
Hospice Care
Available as long as your doctor certifies you are terminally ill and you elect to receive these services. All but very limited coinsurance for outpatient drugs and inpatient respite care $0 Balance
 

PLAN C

MEDICARE (PART B) - MEDICAL SERVICES PER CALENDAR PERIOD

* Once you have been billed $155 of Medicare-approved amounts for covered services (which are noted with an asterisk), your Part B Deductible will have been met for the calendar year.

Services Medicare Pays Plan C Pays You Pay
Medical Expenses  -  In or out of the hospital and outpatient hospital treatment, such as Physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, durable medical equipment.
First $155 of Medicare-Approved Amounts* $0 $155
(Part B deductible)		 $0
Remainder of Medicare-Approved Amounts 80%
(Generally)		 20%
(Generally)		 $0
Part B Excess Charges (Above Medicare-Approved Amounts) $0 $0 All Costs
 
Blood
First 3 pints $0 All Costs $0
Next $155 of Medicare-Approved Amounts* $0 $155
(Part B deductible)		 $0
Remainder of Medicare-Approved Amounts 80% 20% $0
 
Clinical Laboratory Services - Blood tests for diagnostic services
  100% $0 $0
 
MEDICARE (PARTS A & B)
Home Health Care Medicare - Approved Services
- Medically necessary skilled care services and medical supplies 100% $0 $0
- Durable medical equipment      
- First $155 of Medicare-Approved Amounts* $0 $155
(Part B deductible)		 $0
- Remainder of Medicare-Approved Amounts 80% 20% $0
 
OTHER BENEFITS - NOT COVERED BY MEDICARE
Preventative Medical Care Benefit - Not covered by Medicare
Some annual physical and preventive tests and services such as: digital rectal exam, hearing screening, dipstick urinalysis, diabetes screening, thyroid function test, tetanus and diphtheria booster and education, administered or ordered by your doctor when not covered by Medicare
First $120 each calendar year $0 $0 $120
Additional charge $0 $0 All costs
 
Foreign Travel - Not covered by Medicare Medically necessary
Emergency care services beginning during the first 60 days of each trip outside the USA
First $250 each calendar year $0 $0 $250
Remainder of charges $0 80% to a lifetime maximum benefit of $50,000 20% and amounts over the $50,000 lifetime maximum

Click here to view the premiums for this plan

Need Assistance?

If you have questions, please call 918-594-5323 or 1-800-642-8065, call Monday through Friday, 8 a.m. - 5 p.m. Hearing impaired individuals may call TTY/TDD via Relay Oklahoma at 1-800-722-0353 during the same hours.

Don't forget to check out the CommunityCare65 Seminar Schedule. These seminars will teach you everything you'll need to know about our CommuntyCare65 Plans. Click the link below to view the current seminar schedule.