| Part A Hospital Services | A | B | D | F | 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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$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 |
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$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 |
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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$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 |
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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$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 |
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 | D | F | 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 | D | F | G | G-ded | K | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
| Hospice coverage | |
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$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 |
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 | D | F | G | G-ded | K | L | M | N |
| Anthem | 535.92 | S: 927.56 I: Additional benefits included with Anthem Innovative plan rider
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665.78 | 716.34 | ||||||
| Blue Shield eff 7/1/2024 | 481.00 | 967.00 | S: 787.00 Extra Rider
E: 819.00 |
653 | ||||||
| Blue Shield to 6/30/2024 | 481.00 | 892.00 | S: 726.00 Extra Rider
E: 756.00 |
603 | ||||||
| United American | 326.00 | 464.00 | 611.00 | 694.00 | 581.00 | 147.00 | 280.00 | 396.00 | 486.00 | |
| UHC to 5/31/2024 | 417.37 | 582.75 | 705.93 | 551.81 | 387.56 | 467.43 | ||||
| UHC eff 6/1/2024 | 465.75 | 649.68 | 787.50 | 615.93 | 432.00 | 521.43 | ||||
| Choosing a Medigap Policy | ||||||||||
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Prepared for Gerry Silverman
Zip code: 91604 Age: 81 Spouse: 79 |
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UHC rates based on Part B effective 10 or more years UHC spousal rates based on Part B effective less than 10 years
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