| Part A Hospital Services | A | F | G | 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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| 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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| 3 Pints of (unreplaced) blood | |
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| Part B Services | A | F | G | 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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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 | F | G | N |
| Out of Pocket Limit | NA | NA | NA | NA |
| Hospice coverage | |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | F | G | N |
| Anthem | 181.84 | S: 314.76 I: Additional benefits included with Anthem Innovative plan rider
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225.92 | 243.07 |
| Blue Shield to 6/30/2024 | 156.00 | 265.00 | S: 218.00 Extra Rider
E: 233.00 |
197 |
| Health Net | 180.00 | S: 257.00 Additional benefits included with Health Net Innovative plan rider
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S: 229.00 Additional benefits included with Health Net Innovative plan rider
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194.00 |
| Humana Achieve to 7/31/2024 | 197.51 | 240.46 | 207.79 | 163.14 |
| ManhattanLife | 222.00 | 273.92 | 223.17 | 172.42 |
| UHC to 5/31/2024 | 146.55 | 247.86 | 193.75 | 164.12 |
| Choosing a Medigap Policy | ||||
| ManhattanLife: Add $25 application fee. | ||||
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Prepared for
Zip code: 92804 Age: 70 |
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UHC rates based on Part B effective less than 10 years
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