| Part A Hospital Services | F | G |
|---|---|---|
| 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) |
 |
|
|
|
|
| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
|
| Skilled nursing facility coinsurance | |
|
| 3 Pints of (unreplaced) blood | |
|
| Part B Services | F | G |
| 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 |
| Out of Pocket Limit | NA | NA |
| Hospice coverage | |
|
| Foreign Travel Emergency | |
|
| Monthly Rates & Brochures | F | G |
| Anthem | S: 481.73 I: Additional benefits included with Anthem Innovative plan rider
|
345.78 |
| Blue Shield eff 7/1/2024 | 509.00 | S: 413.00 Extra Rider
E: 429.00 |
| Blue Shield to 6/30/2024 | 469.00 | S: 381.00 Extra Rider
E: 396.00 |
| Continental (Aetna) | 563.44 | 412.92 |
| Health Net | S: 387.00 Additional benefits included with Health Net Innovative plan rider
|
S: 345.00 Additional benefits included with Health Net Innovative plan rider
|
| Humana Achieve to 7/31/2024 | 352.08 | 312.47 |
| Humana Achieve eff 8/1/2024 | 378.34 | 335.76 |
| ManhattanLife | 432.58 | 350.67 |
| National Health Ins | 433.47 | 369.30 |
| Physicians Mutual | 356.23 | 310.88 |
| United American | 470.00 | 393.00 |
| UHC to 5/31/2024 | 313.75 | 245.25 |
| UHC eff 6/1/2024 | 350.00 | 273.75 |
| Blue Shield Frozen Plan F $520 | ||
| Choosing a Medigap Policy | ||
| Continental: Add $20 application fee. | ||
| ManhattanLife: Add $25 application fee. | ||
|
Prepared for
Zip code: 91201 Age: 81 |
|
UHC rates based on Part B effective less than 10 years
|