Part A Hospital Services | F | F-ded | G | 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) |
$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 | ||||
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 |
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Part B Services | F | F-ded | G | 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 |
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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 | N |
Out of Pocket Limit | 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 |
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Foreign Travel Emergency | ||||
Monthly Rates & Brochures | F | F-ded | G | N |
Anthem | S: 397.32 I: Additional benefits included with Anthem Innovative plan rider
See page 21 or 22 in Anthem brochure for details |
285.18 | 306.84 | |
Blue Shield | 380.00 | S: 318.00 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: 335.00 |
292 | |
Cigna | 363.87 | 85.33 | 296.38 | 211.97 |
Health Net | S: 320.00 Additional benefits included with Health Net Innovative plan rider
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138.00 | S: 286.00 Additional benefits included with Health Net Innovative plan rider
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227.00 |
UHC | 339.50 | 265.54 | 224.80 | |
Choosing a Medigap Policy |
Prepared for Karen McLain
Zip code: 90803 Age: 76 |
UHC rates based on Part B effective less than 10 years
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