| Part A Hospital Services | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
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| 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 |
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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 |
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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 |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
Plan covers 50% Part A deductible50% | |
| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
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| Skilled nursing facility coinsurance | |
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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 |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| 3 Pints of (unreplaced) blood | |
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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 |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| Part B Services | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| 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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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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You pay $20 for Dr. office visits You pay $50 for emergency room visits$20/$50 |
| 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 | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
| Hospice coverage | |
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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 |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Anthem | 263.05 | S: 440.06 I: Additional benefits included with Anthem Innovative plan rider
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311.76 | 328.84 | ||||||||
| Blue Shield eff 7/1/2024 | 243.00 | 474.00 | S: 384.00 Extra Rider
E: 400.00 |
329 | ||||||||
| Blue Shield to 6/30/2024 | 243.00 | 437.00 | S: 354.00 Extra Rider
E: 369.00 |
303 | ||||||||
| Continental (Aetna) | 232.16 | 293.47 | 411.25 | 76.97 | 301.38 | 226.24 | ||||||
| Health Net | 242.00 | 321.00 | S: 345.00 Additional benefits included with Health Net Innovative plan rider
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149.00 | S: 308.00 Additional benefits included with Health Net Innovative plan rider
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141.00 | 278.00 | |||||
| Humana Achieve | 232.31 | 295.61 | 262.40 | 87.60 | 218.05 | |||||||
| ManhattanLife | 268.08 | 332.42 | 269.42 | 231.08 | ||||||||
| National Health Ins | 275.71 | 361.23 | 105.81 | 307.75 | 243.20 | |||||||
| Physicians Mutual | 232.73 | 315.71 | 275.59 | 229.12 | ||||||||
| United American to 4/30/2024 | 159.00 | 226.00 | 324.00 | 295.00 | 331.00 | 70.00 | 274.00 | 70.00 | 140.00 | 198.00 | 225.00 | |
| United American eff 5/1/2024 | 163.00 | 232.00 | 340.00 | 310.00 | 352.00 | 76.00 | 295.00 | 76.00 | 140.00 | 198.00 | 247.00 | |
| UHC to 5/31/2024 | 179.75 | 250.75 | 302.50 | 304.00 | 237.50 | 167.00 | 201.25 | |||||
| UHC eff 6/1/2024 | 200.50 | 279.75 | 337.50 | 339.00 | 265.00 | 186.00 | 224.50 |
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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
# Office Visits per Month
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