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Per Diem For 31 Days Skilled $326.66 $10,126.46 Ventilator $653.32 $20,252.92

3. HOSPITAL SWING BEDS A swing bed is certified as a swing bed by Medicare. Not all hospitals have swing beds. Swing bed rates are the same as Hospital Inappropriate Level of Care beds. 4. HOSPICE CARE IN A NURSING FACILITY The business office of the Hospice agency can verify the actual rate for room and board and other services provided to the specific individual. Or contact the Budget Management Section of the Division of Health Benefits at 919/855-4200. Be prepared to state the patient's level of care and the name and address of the nursing facility.

TABLE B – MEDICARE CO-PAYMENT AMOUNTS Effective 01-01-26 MEDICARE PART A A. Approved Medicare SNF in a Nursing Facility 1. 1-20 days SNF --- no co-pay. 2. 21-100 days --- $217 per day. B. PART A Hospitalization Benefits 1. First 60 days --- Medicare Part A deductible, $1,736 total. 2. 61st through 90th day --- $434 per day. 3. 91st – 150th Lifetime reserve days --- $868.00 per day.

TABLE C -- STANDARD UTILITY ALLOWANCE Effective 01/01/26

Household Size Standard Allowance 1 $637 2 $699 3 $768 4 $837 5 $912

Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493

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Official source

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Per Diem For 31 Days Skilled $326.66 $10,126.46 Ventilator $653.32 $20,252.92

3. HOSPITAL SWING BEDS A swing bed is certified as a swing bed by Medicare. Not all hospitals have swing beds. Swing bed rates are the same as Hospital Inappropriate Level of Care beds. 4. HOSPICE CARE IN A NURSING FACILITY The business office of the Hospice agency can verify the actual rate for room and board and other services provided to the specific individual. Or contact the Budget Management Section of the Division of Health Benefits at 919/855-4200. Be prepared to state the patient's level of care and the name and address of the nursing facility.

TABLE B – MEDICARE CO-PAYMENT AMOUNTS Effective 01-01-26 MEDICARE PART A A. Approved Medicare SNF in a Nursing Facility 1. 1-20 days SNF --- no co-pay. 2. 21-100 days --- $217 per day. B. PART A Hospitalization Benefits 1. First 60 days --- Medicare Part A deductible, $1,736 total. 2. 61st through 90th day --- $434 per day. 3. 91st – 150th Lifetime reserve days --- $868.00 per day.

TABLE C -- STANDARD UTILITY ALLOWANCE Effective 01/01/26

Household Size Standard Allowance 1 $637 2 $699 3 $768 4 $837 5 $912

Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493