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Call CommunityCare65 at 918-594-5323 or 1-800-642-8065, TTY/TDD call 1-800-722-0353 for more information and rate quotes.

2017 CommunityCare65 Plan A

Plan A

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 A Benefit Summary
Services Medicare Pays Plan A Pays You Pay
Hospitalization* Semiprivate room and board, general nursing, miscellaneous services and supplies
First 60 days All but $1,316 $0 $1,316
(Part A deductible)
61st through 90th day All but $329 a day $329 a day $0
91st day and after      
  • While using 60 lifetime reserve days
All but $658 a day $658 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 $164.50 a day $0 Up to $164.50 a day
101st day and after $0 $0 All Costs
 
Blood
First 3 pints $0 All Costs $0
Additional amounts 100% $0 $0
 
Hospice Care
You must meet Medicare’s requirements, including a doctor’s certification of terminal illness. All but very limited copayment/coinsurance for outpatient drugs and inpatient respite care. Medicare Copayment/Coinsurance $0
*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.
**NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy’s “Core Benefits.” During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.
 

PLAN A

MEDICARE (PART B) - MEDICAL SERVICES PER CALENDAR PERIOD

* Once you have been billed $183 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 A 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 $183 of Medicare-Approved Amounts* $0 $0 $183
(Part B deductible)
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 $183 of Medicare-Approved Amounts* $0 $0 $183
(Part B deductible)
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 $183 of Medicare-Approved Amounts*
$0 $0 $183
(Part B deductible)
  • Remainder of Medicare-Approved Amounts
80% 20% $0
 

Need Assistance?

If you have questions, please call 918-594-5351 or 1-877-862-1356, 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.