| Part A Hospital Services | F | F-ded | 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) |
 |
$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 |
|
| 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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| 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 |
|
| Part B Services | F | F-ded | G |
| Part B Annual Deductible ($240) | |
||
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
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| 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 | F | F-ded | G |
| Out of Pocket Limit | NA | 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 |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | F-ded | G |
| Anthem | S: 367.77 I: Additional benefits included with Anthem Innovative plan rider
|
263.99 | |
| Blue Shield eff 7/1/2024 | 336.00 | S: 283.00 Extra Rider
E: 298.00 |
|
| Blue Shield to 6/30/2024 | 304.00 | S: 256.00 Extra Rider
E: 270.00 |
|
| UHC to 5/31/2024 | 285.51 | 223.18 | |
| UHC eff 6/1/2024 | 318.50 | 249.11 |
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Prepared for 7602
Zip code: 90046 Age: 74 |
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UHC rates based on Part B effective less than 10 years
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