Services Medicare Pays Plan Pays You Pay HOME HEALTH CARE – Medicare Approved Services: Medically necessary skilled care services and medical supplies 100% $0 $0 DURABLE MEDICAL EQUIPMENT First of Medicare Approved Amounts** $0 $0 Part B Deductible Next Medicare-approved amounts Generally 80% $0 20% until Calendar year deductible is met ($400) Next Medicare-approved amounts Generally 80% 16% 4% until Out Of Pocket Maximum is met ($1,250) Remainder of Medicare Approved Amounts 80% 20% $0 Medicare Parts A & B Services Medicare Pays Plan Pays You Pay FOREIGN TRAVEL - 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 of $50,000 20% and amounts over the $50,000 lifetime max Benefits Not Covered By Medicare