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Part A Hospital Services	F	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)		$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded
The inpatient deductible is $1632 for each benefit period Days 1-60: Medicare covers 100% Days 61-90: You are responsible for $408 per day Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day Beyond lifetime reserve: You are responsible for all costs incurred Hospital Coinsurance		$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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
Skilled nursing facility coinsurance		$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded
3 Pints of (unreplaced) blood		$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded
Part B Services	F	G-ded
Part B Annual Deductible ($240)
Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance
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
Additional Features	F	G-ded
Out of Pocket Limit	NA	NA
Hospice coverage		$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded
Foreign Travel Emergency
Monthly Rates & Brochures	F	G-ded
Anthem CKHH	S: 481.73 I: Additional benefits included with Anthem Innovative plan rider Vision Benefits Routine eye exam In network: No Charge Out of network: $35 Allowance Eyeglass Frames In network: $100 allowance Out of network: $45 Allowance Eyeglass Lenses Single vision - In network:100% coverage after $25 copay Out of network:$25 benefit after $25 copay Bifocal - In network:100% coverage after $25 copay Out of network:$40 benefit after $25 copay Trifocal or Lenticular - In network:100% coverage after $25 copay Out of network:$55 benefit after $25 copay Contact Lenses In network: $100 allowance Out of network: $80 Allowance Hearing Benefits Coverage through Hearing Care Solutions Hearing exam: 100% coverage Hearing aids: Coverage allowance up to $750 per year Other Innovative Plan Benefits Nurse help line: Speak with a Registered nurse about health related questions Other Benefits (included with both Standard and Innovative Plans) SilverSneakers gym membership See page 21 or 22 in Anthem brochure for details 474.30
Blue Shield eff 7/1/2024 CKHH	509.00
Continental (Aetna) HH	501.72
Health Net	S: 387.00 Additional benefits included with Health Net Innovative plan rider Vision Benefits Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance Medically necessary contact Lenses - Up to $250 allowance Hearing Benefits Routine Hearing Exam - One hearing exam every 12 months Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions Level 4 - You pay $1580 Level 3 - You pay $1125 Level 2 - You pay $700 Level 1 - You pay $0 See page 44 in Health Net brochure for detailsI: 393.00	133.00
Humana Achieve eff 8/1/2024CKHH	378.34	104.06
ManhattanLife HH	432.58
National Health InsHH	433.47
Physicians Mutual CKHH	356.23
United American eff 5/1/2024	470.00	102.00
UHC CKHH	437.50
Choosing a Medigap Policy
Continental: Add $20 application fee.
ManhattanLife: Add $25 application fee.

Part A Hospital Services

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)

$2800 annual deductible applies

You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year

After that coverage is 100%

after
ded

The inpatient deductible is $1632 for each benefit period
Days 1-60: Medicare covers 100%
Days 61-90: You are responsible for $408 per day
Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day
Beyond lifetime reserve: You are responsible for all costs incurred

Hospital Coinsurance

$2800 annual deductible applies

You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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

Skilled nursing facility coinsurance

$2800 annual deductible applies

You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year

After that coverage is 100%

after
ded

3 Pints of (unreplaced) blood

$2800 annual deductible applies

You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year

After that coverage is 100%

after
ded

Part B Services

G-ded

Part B Annual Deductible ($240)

Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance

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

Additional Features

G-ded

Out of Pocket Limit

Hospice coverage

$2800 annual deductible applies

You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year

After that coverage is 100%

after
ded

Foreign Travel Emergency

Monthly Rates & Brochures

G-ded

Anthem CKHH

S: 481.73
I: Additional benefits included with Anthem Innovative plan rider

Vision Benefits
Routine eye exam In network: No Charge Out of network: $35 Allowance
Eyeglass Frames In network: $100 allowance Out of network: $45 Allowance
Eyeglass Lenses
- Single vision - In network:100% coverage after $25 copay Out of network:$25 benefit after $25 copay
- Bifocal - In network:100% coverage after $25 copay Out of network:$40 benefit after $25 copay
- Trifocal or Lenticular - In network:100% coverage after $25 copay Out of network:$55 benefit after $25 copay
Contact Lenses In network: $100 allowance Out of network: $80 Allowance
Hearing Benefits Coverage through Hearing Care Solutions
Hearing exam: 100% coverage
Hearing aids: Coverage allowance up to $750 per year
Other Innovative Plan Benefits
Nurse help line: Speak with a Registered nurse about health related questions
Other Benefits (included with both Standard and Innovative Plans)
SilverSneakers gym membership

See page 21 or 22 in Anthem brochure for details

474.30

Blue Shield eff 7/1/2024 CKHH

509.00

Continental (Aetna) HH

501.72

Health Net

S: 387.00
Additional benefits included with Health Net Innovative plan rider

Vision Benefits
Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
Medically necessary contact Lenses - Up to $250 allowance
Hearing Benefits
Routine Hearing Exam - One hearing exam every 12 months
Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
- Level 4 - You pay $1580
- Level 3 - You pay $1125
- Level 2 - You pay $700
- Level 1 - You pay $0

See page 44 in Health Net brochure for detailsI: 393.00

133.00

Humana Achieve eff 8/1/2024CKHH

378.34

104.06

ManhattanLife HH

432.58

National Health InsHH

433.47

Physicians Mutual CKHH

356.23

United American eff 5/1/2024

470.00

102.00

UHC CKHH

437.50

Choosing a Medigap Policy

Continental: Add $20 application fee.

ManhattanLife: Add $25 application fee.

Select all that apply

Anthem $2 per month
Physicians Mutual $5 per month

Automatic Checking Withdrawal Discount

If you are new to Medicare the following monthly discounts
are available for your first year of coverage

Anthem Plan F: $20 Plans G: $25 per month
Blue Shield Plans A. F and G: $25 per month
Health Net All Plans: $30 per month
United Healthcare Plan G: $25 per month

Welcome to Medicare discount 2 party

Anthem Plan F rates reflect $20 Welcome to Medicare discount.

Anthem Plan F rates reflect $40 2 party Welcome to Medicare discount.

Anthem Plan G rates reflect $25 Welcome to Medicare discount.

Anthem Plan G rates reflect $50 2 party Welcome to Medicare discount.

Enrollees who live with another Anthem Medicare Supplement
member may qualify for a household discount.

For members with an original Anthem Blue Cross
effective date after 2/28/2023 the discount is 10%
For those with original effective dates between
6/1/2010 and 2/28/2023 the discount is 5%
The household discount is not available to persons
enrolled before 6/1/2010

Anthem household discount

Anthem rates reflect $2 automatic checking discount.

Blue Shield Plan G rates reflect $25 Welcome to Medicare discount.

Blue Shield Plan G rates reflect $50 2 party Welcome to Medicare discount.

Blue Shield rates reflect $3 automatic checking discount.

Blue ShieldYou are eligible for a 7% household premium discount

if you reside with another person who is on the same Blue Shield Medicare Supplement plan
including same Dental plan.

Only one policy will be issued, the second party will be covered as a dependent. household discount (7%)

Continental Life You are be eligible for a 5% discount if you reside with another
person covered by Continental Life who is either
(a) your spouse;
(b) someone with whom you are in a civil union partnership;
(c) a permanent resident in your home.5% household discount

Health Net rates reflect $30 Welcome to Medicare discount.

Health Net rates reflect $60 2 party Welcome to Medicare discount.

Humana Achieve rates reflect $2 automatic checking discount.

ManhattanLifeManhattanLife offers a 7% household premium discount

if you are marriied and residing with your spouse
or have been residing, for at the past 12 months, with someone who is 60 or over

household discount (7%)

National Health Insurance National Health Insurance

You are eligible for a 7% household premium discount if you have a roommate
You are eligible for a 10% discount if multiple people in your household are
covered by National Health Ins. medicare supplement policies

household discount

Physicians Mutual rates reflect $5 automatic checking discount.

Physicians Mutual 10% Physicians Mutual offers a 10% household premium discount
if you are marriied
or reside with another person age 60 or over.household discount

UHC Plan G rates reflect $25 Welcome to Medicare discount.

UHC Plan G rates reflect $50 2 party Welcome to Medicare discount.

United Healthcare rates reflect $2 automatic checking discount.

UHC/AARPYou can take 7% off your monthly premiums if

two or more members are enrolled under the same AARP membership number
and each is insured under an eligible AARP-branded supplemental insurance
policy insured by UnitedHealthcare Insurance Company.

household discount (7%)