| Part A Hospital Services | A | B | 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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$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 |
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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 | |
$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% |
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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 |
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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 | 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 | F | F-ded | 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 |
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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 | F | F-ded | G | G-ded | K | L | M | N |
| Anthem | 202.41 | S: 331.79 I: Additional benefits included with Anthem Innovative plan rider
See page 21 or 22 in Anthem brochure for details |
226.95 | 271.22 | ||||||
| Blue Shield | 150.00 | 272.00 | S: 223.00 Extra Rider
E: 241.00 |
247 | ||||||
| Continental (Aetna) | 224.99 | 284.89 | 399.01 | 74.39 | 292.47 | 214.00 | ||||
| Health Net | 179.00 | S: 269.00 Additional benefits included with Health Net Innovative plan rider
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99.00 | S: 237.00 Additional benefits included with Health Net Innovative plan rider
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76.00 | 180.00 | ||||
| Humana Achieve | 229.24 | 281.26 | 245.16 | 79.22 | 181.96 | |||||
| Physicians Mutual | 221.91 | 277.26 | 241.49 | 200.00 | ||||||
| United American | 154.00 | 213.00 | 301.00 | 58.00 | 250.00 | 58.00 | 130.00 | 185.00 | 207.00 | |
| UHC | 180.16 | 252.10 | 306.00 | 213.90 | 166.96 | 201.94 | ||||
| Choosing a Medigap Policy | ||||||||||
| Continental: Add $20 application fee. | ||||||||||
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Prepared for Mark Beckett
Zip code: 91711 Age: 73 |
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Anthem rates reflect $2 automatic checking discount
Anthem Plan F rates reflect $20.00 Welcome to Medicare discount
Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield rates reflect $3 automatic checking discount
Blue Shield Plan F rates reflect $25 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
Humana Achieve rates reflect $2 automatic checking discount
Physicians Mutual rates reflect $5 automatic checking discount
UHC rates based on Part B effective less than 10 years UHC Plan G rates reflect $25 Welcome to Medicare discount
UHC rates reflect $2 automatic checking discount
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