| Part A Hospital Services | A | B | D | 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 | |
$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 | G-ded | K | L | M | N |
| Part B Annual Deductible ($240) | ||||||||
| 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 | G-ded | K | L | M | N |
| Out of Pocket Limit | 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 | G-ded | K | L | M | N |
| Anthem Application | 324.14 | 433.29 | ||||||
| Blue Shield Application | 226.10 | 340.38 | ||||||
| Continental (Aetna) | 358.61 | 453.49 | 318.67 | |||||
| United American Application | 332.00 | 451.00 | 539.00 | 113.00 | 278.00 | 394.00 | 422.00 | |
| UHC Application | 289.80 | 404.25 | 268.80 | 324.45 | ||||
| United World Life | 350.11 | 130.55 | 305.46 | |||||
| Choosing a Medigap Policy | ||||||||
| Continental: Add $20 application fee. | ||||||||
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Prepared for Geralyn Araujo
Zip code: 91350 Age: 65 Spouse: 69 |
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Blue Shield rates reflect 7% You 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 UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years UHC Plan G rates reflect $25 Welcome to Medicare discount
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