| Monthly premium: Part A/Part B | $375/$78.20 |
| Part A coverage First 60 days patient paid deductible Next 30 days patient pays per day Next 60 days patient pays per day Over 150 days patient pays per day |
$912 $228 $456 All costs |
| Part B coverage Deductible Coinsurance |
$110 20% |
| Skilled Nursing Benefits First 20 days patient pays per day Next 80 days patient pays per day Over 100 days patient pays per day |
$0 $114 All costs |
