Vermont Blue 65 Plan N

Preventive services help you stay healthy, find health problems early, determine treatment plans, and prevent certain diseases. Preventive services include exams, vaccines, lab tests, and screenings. You pay $0 for most preventive services when provided by a healthcare provider who accepts Medicare assignment. For a complete list of Medicare-covered preventive services, visit Medicare.gov

A visit to a healthcare provider who provides primary, routine care services.

A visit to a healthcare provider that is considered a medical specialist, such as an orthopedic surgeon or cardiologist.

Health care services that are necessary to treat a condition or illness of an individual that if not treated within 24 hours would cause risk.

Care for illness or injuries that need immediate attention and care.

Transportation provided to the nearest facility or hospital, such as by a ground or air ambulance service.

Not covered by Medicare. Coverage is available for medically necessary emergency care services beginning during the first 60 days of each trip outside the U.S. A $250 annual deductible applies with a $50,000 lifetime maximum. You are responsible for all costs over the lifetime maximum. 

You will need to submit claims to us for services received in a foreign country.

If applicable, the amount shown for Medicare Part B covered services indicates what you will pay once the annual Part B deductible is met. The amount shown for Medicare Part A covered services indicates what you will pay once Medicare and the Plan have paid their share.

Diagnostic laboratory tests can help find changes in your health and helps your doctor or other healthcare provider diagnose or rule out an illness or condition. Medicare Part B covers medically necessary diagnostic laboratory tests when your healthcare provider orders them, and you usually pay $0 for Medicare-covered diagnostic laboratory tests. 

Diagnostic radiology services include scans such as MRIs, CTs and other imaging.

X-ray services provided as outpatient care.

Covers the cost for medically necessary equipment, such as hospital beds, oxygen equipment, insulin pumps, canes, and more.

Covers many diagnostic and treatment services you get as an outpatient from a hospital.

Covers facility fees related to approved surgical procedures you get in ambulatory surgical centers.

Covers a wide range of outpatient mental health services, including psychiatric evaluation, medication management, outpatient programs, substance use disorder treatment, and more.

If applicable, the amount shown for Medicare Part B covered services indicates what you will pay once the annual Part B deductible is met. The amount shown for Medicare Part A covered services indicates what you will pay once Medicare and the Plan have paid their share.

Medical care when you get admitted to a health care facility, like a hospital or other type of inpatient facility and spend at least one night. Coverage for semiprivate room and board, general nursing, and miscellaneous services and supplies. 

You plan's coverage for limited stays in a skilled nursing facility. You must meet Medicare’s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days after leaving the hospital. 

If applicable, the amount shown for Medicare Part B covered services indicates what you will pay once the annual Part B deductible is met. The amount shown for Medicare Part A covered services indicates what you will pay once Medicare and the Plan have paid their share.