Plan A
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part B coinsurance or copayment
- Blood (first 3 pints)
- Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Part A deductible
- Part B deductible
- Part B excess charges
- Foreign travel emergency
- Out-of-pocket limit** (N/A)