| Part A Hospital Services | A | B | C | D | F | F-ded | G | G-ded | 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 |
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| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
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| Skilled nursing facility coinsurance | |
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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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| 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 |
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| Part B Services | A | B | C | D | F | F-ded | G | G-ded | 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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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 | C | D | F | F-ded | G | G-ded | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | NA | 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 |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | B | C | D | F | F-ded | G | G-ded | N |
| Anthem | 247.89 | S: 429.05 I: Additional benefits included with Anthem Innovative plan rider
See page 21 or 22 in Anthem brochure for details |
307.98 | 331.37 | |||||
| Blue Shield | 236.00 | 440.00 | S: 364.00 Note: Silver Sneakers gym membership is included with all Blue Shield plans. Additonal benefits with Blue Shield Extra RiderForeign Travel - Not covered by Medicare
Physician Consultation by Phone or Video Through Teledoc
Over-the-Counter Items through CVS
Accupuncture and Chiropractic Services (provided by AHS provider network)
Vision Coverage (provided by Vision Service Plan)
Hearing Aid Services (provided by Epic Hearing Healthcare)
E: 380.00 |
318 | |||||
| Health Net | 238.00 | 314.00 | S: 341.00 Additional benefits included with Health Net Innovative plan rider
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148.00 | S: 303.00 Additional benefits included with Health Net Innovative plan rider
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137.00 | 270.00 | ||
| Humana Achieve | 272.12 | 339.70 | 300.22 | 95.06 | 229.35 | ||||
| United American | 217.00 | 306.00 | 433.00 | 393.00 | 448.00 | 90.00 | 374.00 | 90.00 | 311.00 |
| UHC | 207.00 | 288.75 | 348.25 | 350.00 | 273.75 | 231.75 | |||
| Choosing a Medigap Policy | |||||||||
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Prepared for
Zip code: 92705 Age: 78 |
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UHC rates based on Part B effective less than 10 years
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