| Part A Hospital Services | A | B | C | D | F | F-ded | G | G-ded | K | L | M | 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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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
Plan covers 50% Part A deductible50% | |
| 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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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| 3 Pints of (unreplaced) blood | |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| Part B Services | A | B | C | D | F | F-ded | G | G-ded | K | L | M | 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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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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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 | K | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
| Hospice coverage | |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Anthem | 135.47 | S: 227.99 I: Additional benefits included with Anthem Innovative plan rider
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160.93 | 169.85 | ||||||||
| Blue Shield eff 7/1/2024 | 124.00 | 227.00 | S: 175.00 Extra Rider
E: 192.00 |
174 | ||||||||
| Blue Shield to 6/30/2024 | 124.00 | 209.00 | S: 161.00 Extra Rider
E: 177.00 |
160 | ||||||||
| Continental (Aetna) | 0.00 | 0.00 | 0.00 | 0.00 | ||||||||
| Health Net | 0.00 | 0.00 | S: 0.00 Additional benefits included with Health Net Innovative plan rider
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0.00 | S: 0.00 Additional benefits included with Health Net Innovative plan rider
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0.00 | 0.00 | |||||
| Humana Achieve | 157.03 | 192.55 | 166.83 | 55.09 | 130.14 | |||||||
| ManhattanLife | 134.67 | 166.83 | 135.42 | 115.00 | ||||||||
| National Health Ins | 160.79 | 210.28 | 61.65 | 179.34 | 141.71 | |||||||
| Physicians Mutual | 165.30 | 206.54 | 179.86 | 148.97 | ||||||||
| United American to 4/30/2024 | 122.00 | 166.00 | 218.00 | 193.00 | 222.00 | 40.00 | 180.00 | 40.00 | 106.00 | 149.00 | 144.00 | |
| United American eff 5/1/2024 | 125.00 | 170.00 | 228.00 | 202.00 | 237.00 | 44.00 | 193.00 | 44.00 | 106.00 | 149.00 | 159.00 | |
| UHC to 5/31/2024 | -2.00 | -2.00 | -2.00 | -2.00 | ||||||||
| UHC eff 6/1/2024 | -2.00 | -2.00 | -2.00 | -2.00 |
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Prepared for Zip code: 93349 Age: 67 |
| Select all that apply |
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If you are new to Medicare the following monthly discounts
are available for your first year of coverage
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Enrollees who live with another Anthem Medicare Supplement
member may qualify for a household discount.
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Blue ShieldYou are eligible for a 7% household premium discount
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Humana AchieveHumana Achieve offers a 12% household premium discount
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ManhattanLifeManhattanLife offers a 7% household premium discount
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National Health Insurance National Health Insurance
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Physicians Mutual 10% Physicians Mutual offers a 10% household premium discount
if you are marriied or reside with another person age 60 or over.household discount |
UHC/AARPYou can take 7% off your monthly premiums if
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| Contact us |
| (619) 463-5475 |
| [email protected] |
| CA Ins Lic 0827043 |