| Part A Hospital Services | F | F-ded | G-ded |
|---|---|---|---|
| The Part A deductible is $1632 per benefit period A benefit period starts when you are admitted to a facility and ends 60 days after you last received inpatient care at any facilityPart A Deductible ($1632) |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
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| Skilled nursing facility coinsurance | |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
| 3 Pints of (unreplaced) blood | |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
| Part B Services | F | F-ded | G-ded |
| Part B Annual Deductible ($240) | |
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| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
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| Doctors who do not take Medicare Assignment can charge 15% above what medicare allows Some Medicare Supplement plans cover that extra 15%Part B Excess Charges |
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| Additional Features | F | F-ded | G-ded |
| Out of Pocket Limit | NA | NA | NA |
| Hospice coverage | |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | F-ded | G-ded |
| Anthem | S: 440.06 I: Additional benefits included with Anthem Innovative plan rider
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| Blue Shield eff 7/1/2024 | 474.00 | ||
| Blue Shield to 6/30/2024 | 437.00 | ||
| Continental (Aetna) | 411.25 | 76.97 | |
| Health Net | S: 345.00 Additional benefits included with Health Net Innovative plan rider
|
149.00 | 141.00 |
| Humana Achieve | 295.61 | 87.60 | |
| ManhattanLife | 332.42 | ||
| National Health Ins | 361.23 | 105.81 | |
| Physicians Mutual | 315.71 | ||
| United American to 4/30/2024 | 331.00 | 70.00 | 70.00 |
| United American eff 5/1/2024 | 352.00 | 76.00 | 76.00 |
| UHC to 5/31/2024 | 304.00 | ||
| UHC eff 6/1/2024 | 339.00 |
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Prepared for davis
Zip code: 92069 Age: 81 |
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UHC rates based on Part B effective less than 10 years
Lowest cost plans
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