ZapIndex

Part A Hospital Services	A	B	D	G	G-ded	K	L	M	N
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)					$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
The inpatient deductible is $1632 for each benefit period Days 1-60: Medicare covers 100% Days 61-90: You are responsible for $408 per day Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day Beyond lifetime reserve: You are responsible for all costs incurred Hospital 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%	Plan covers 50% Part A deductible50%
Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage
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%
3 Pints of (unreplaced) blood					$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%
Part B Services	A	B	D	G	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						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%		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
Additional Features	A	B	D	G	G-ded	K	L	M	N
Out of Pocket Limit	NA	NA	NA	NA	NA	$5120	$2560	NA	NA
Hospice coverage					$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%
Foreign Travel Emergency
Monthly Rates & Brochures	A	B	D	G	G-ded	K	L	M	N
Anthem CKHH	174.85			192.24					233.74
Blue Shield eff 7/1/2024 CKHH	120.00			S: 188.00 Note: Silver Sneakers gym membership is included with all Blue Shield plans. Additonal benefits with Blue Shield Extra Rider Foreign Travel - Not covered by Medicare $250 annual deductible, 80% coverage, $50,000 lifetime max (Click the Brochure link, see page 20) Physician Consultation by Phone or Video Through Teledoc No charge (see brochure page 20) Over-the-Counter Items through CVS Up to $100 allowance per quarter (see brochure page 20) Accupuncture and Chiropractic Services (provided by AHS provider network) Up to 20 visits per year, plan pays 100%, see page 21 in brochure for details Vision Coverage (provided by Vision Service Plan) Exam every 12 months, eyeglasses every 24 months, click the brochure link for details (see page 21) Hearing Aid Services (provided by Epic Hearing Healthcare) Routine hearing exams, copayments for hearing aids, see page 23 of brochure for details E: 205.00					198
Continental (Aetna) HH	216.83	274.14		281.55					203.34
United American eff 5/1/2024	182.00	248.00	299.00	285.00	64.00	155.00	219.00		234.00
UHC CKHH	157.32	219.45		183.05			145.92		176.13
United World Life CKHH	190.42			223.80	67.79				166.41
Choosing a Medigap Policy
Continental: Add $20 application fee.

Part A Hospital Services

G-ded

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)

$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

The inpatient deductible is $1632 for each benefit period
Days 1-60: Medicare covers 100%
Days 61-90: You are responsible for $408 per day
Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day
Beyond lifetime reserve: You are responsible for all costs incurred

Hospital 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%

Plan covers 50% Part A deductible50%

Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage

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%

3 Pints of (unreplaced) blood

$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%

Part B Services

G-ded

Part B Annual Deductible ($240)

Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance

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%

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

Additional Features

G-ded

Out of Pocket Limit

$5120

$2560

Hospice coverage

$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%

Foreign Travel Emergency

Monthly Rates & Brochures

G-ded

Anthem CKHH

174.85

192.24

233.74

Blue Shield eff 7/1/2024 CKHH

120.00

S: 188.00

Note: Silver Sneakers gym membership is included with all Blue Shield plans.

Additonal benefits with Blue Shield Extra Rider

Foreign Travel - Not covered by Medicare

$250 annual deductible, 80% coverage, $50,000 lifetime max (Click the Brochure link, see page 20)

Physician Consultation by Phone or Video Through Teledoc

No charge (see brochure page 20)

Over-the-Counter Items through CVS

Up to $100 allowance per quarter (see brochure page 20)

Accupuncture and Chiropractic Services (provided by AHS provider network)

Up to 20 visits per year, plan pays 100%, see page 21 in brochure for details

Vision Coverage (provided by Vision Service Plan)

Exam every 12 months, eyeglasses every 24 months, click the brochure link for details (see page 21)

Hearing Aid Services (provided by Epic Hearing Healthcare)

Routine hearing exams, copayments for hearing aids, see page 23 of brochure for details

E: 205.00

198

Continental (Aetna) HH

216.83

274.14

281.55

203.34

United American eff 5/1/2024

182.00

248.00

299.00

285.00

64.00

155.00

219.00

234.00

UHC CKHH

157.32

219.45

183.05

145.92

176.13

United World Life CKHH

190.42

223.80

67.79

166.41

Choosing a Medigap Policy

Continental: Add $20 application fee.