California PHP

Benefits

Original Medicare

PHP
2023

PHP
2024

Doctor Office Visits

(includes visits to primary care and specialist providers)

20% coinsurance

(You pay 20% of the cost of the visit)

$0 copay per visit to primary care provider (PCP) or specialist.

$0 copay per visit to primary care provider (PCP) or specialist.

Emergency Care

20% coinsurance for the doctor’s services.

Specified copayment for outpatient hospital facility emergency services.

Emergency services copay cannot exceed Part A inpatient hospital deductible for each service provided by the hospital.

$75 copay

$25 copay

Urgently Needed Services

20% coinsurance, or a set copay.

$0 copay

$0 copay

Outpatient Services

20% coinsurance for the doctor’s services.

Specified copayment for outpatient hospital facility services. Copay cannot exceed Part A inpatient hospital deductible.

20% coinsurance for ambulatory surgical center facility services.

$0 copay for outpatient services.

Some services require referral and authorization.

$0 copay for outpatient services.

Some services require referral and authorization.

Diagnostic Tests, X-Rays, Lab Services, and Radiology Services

20% coinsurance for diagnostic tests and x-rays.

$0 copay for Medicare-covered lab services.

You pay nothing for the following services:

• Diagnostic radiology services, e.g., MRI, CT, PET scans
•  Lab services
• Diagnostic tests and procedures
• Outpatient x-rays
• Colonoscopy, sigmoidoscopy,    endoscopy
• Radiation therapy

Referral required. The following services require authorization:

• Certain diagnostic procedures and tests
• Certain diagnostic radiological services
• Certain therapeutic radiological services

The following services do not require authorization:

• Lab
• X-rays

You pay nothing for the following services:

• Diagnostic radiology services, e.g., MRI, CT, PET scans
•  Lab services
• Diagnostic tests and procedures
• Outpatient x-rays
• Colonoscopy, sigmoidoscopy,    endoscopy
• Radiation therapy

Referral required. The following services require authorization:

• Certain diagnostic procedures and tests
• Certain diagnostic radiological services
• Certain therapeutic radiological services

The following services do not require authorization:

• Lab
• X-rays

Inpatient Hospital Care

In 2024, the amounts for each benefit period are:

• $1,632 deductible
• Days 1-60: $0 per day
• Days 61-90: $408 per day
• Days 91-150: $816 per lifetime reserve day

• $100 copay per day for days 1 through 6.
• $0 copay per day for days 7 through 90.
• $0 copay per day for “lifetime reserve” days 91 through 150.

• $100 copay per day for days 1 through 6.
• $0 copay per day for days 7 through 90.
• $0 copay per day for “lifetime reserve” days 91 through 150.

Skilled Nursing Facility (SNF)

In 2024, the amounts for each benefit period are:

• Day 1-20: $0 per day
• Days 21-100: $204 per day

Three-day inpatient hospital stay required before going into SNF.

• $0 copay per day for days 1 through 20.
• $100 copay per day for days 21 through 100.

No prior hospital stay is required.

• $0 copay per day for days 1 through 100.

No prior hospital stay is required.