Medicare Medical Services (Part B) Services Medicare Pays Plan Pays You Pay OUT-PATIENT MEDICAL EXPENSES - In or Out of the Hospital and Out-Patient 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: Medicare Part B Deductible: First 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 Generally 80% Generally 20% 0% Part B Excess Charges (Above Medicare Approve Amounts) $0 100% 0% BLOOD First 3 pints $0 All costs $0 Next 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 CLINICAL LABORATORY SERVICES Blood tests for Diagnostic Services 100% $0 $0