| Part A Hospital Services | A | B | C | D | F | F-ded | G | G-ded | 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 |
|
$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 |
|
|
|
|
|
|
|
|
$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 |
|
$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 | |
|
|
|
|
|
|
|
|
| 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 |
|
$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 |
|
||
| 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 |
|
$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 | A | B | C | D | F | F-ded | G | G-ded | N |
| Part B Annual Deductible ($240) | |
|
|||||||
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
|
|
|
|
|
|
|
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 | C | D | F | F-ded | G | G-ded | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | 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 |
|
$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 |
|
| Foreign Travel Emergency | |
|
|
|
|
|
|
||
| Monthly Rates & Brochures | A | B | C | D | F | F-ded | G | G-ded | N |
| Anthem | 400.24 | S: 743.69 I: Additional benefits included with Anthem Innovative plan rider
See page 21 or 22 in Anthem brochure for details |
541.25 | 559.93 | |||||
| Blue Shield | 457.00 | 828.00 | S: 683.00 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: 717.00 |
618 | |||||
| Health Net | 479.00 | 611.00 | S: 686.00 Additional benefits included with Health Net Innovative plan rider
|
296.00 | S: 611.00 Additional benefits included with Health Net Innovative plan rider
|
281.00 | 527.00 | ||
| Humana Achieve | 408.80 | 511.70 | 452.69 | 143.11 | 346.73 | ||||
| United American | 325.00 | 460.00 | 658.00 | 599.00 | 681.00 | 142.00 | 570.00 | 142.00 | 475.00 |
| UHC | 501.24 | 699.36 | 843.74 | 847.50 | 662.50 | 561.24 | |||
| Choosing a Medigap Policy | |||||||||
|
Prepared for
Zip code: 93283 Age: 77 Spouse: 80 |
|
Humana Achieve rates 12% household discount UHC rates based on Part B effective 10 or more years UHC spousal rates based on Part B effective 10 or more years
|