| Part A Hospital Services | A | B | 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 | 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 | D | F | F-ded | G | G-ded | N |
| Out of Pocket Limit | 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 | 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 | 230.00 | 429.00 | S: 355.00 Extra Rider
E: 372.00 |
310 | ||||
| Cigna | 291.82 | 386.03 | 90.52 | 314.43 | 227.07 | |||
| Continental (Aetna) | 297.13 | 376.18 | 526.71 | 98.46 | 385.93 | 287.72 | ||
| 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 | |
| UHC | 258.75 | 360.93 | 437.50 | 342.18 | 289.68 | |||
| Choosing a Medigap Policy | ||||||||
| Continental: Add $20 application fee. | ||||||||
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Prepared for Patrick Meyer
Zip code: 90745 Age: 78 |
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UHC rates based on Part B effective 10 or more years
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