| Part A Hospital Services | A | B | D | 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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$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 |
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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$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 |
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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$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 |
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 | D | G | G-ded | K | L | M | N |
| Part B Annual Deductible ($240) | |||||||||
| 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 | D | G | G-ded | K | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | $5120 | $2560 | 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 |
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 | D | G | G-ded | K | L | M | N |
| Anthem | 141.09 | 142.21 | 176.38 | ||||||
| Blue Shield eff 7/1/2024 | 94.00 | S: 133.00 Extra Rider
E: 151.00 |
155 | ||||||
| Continental (Aetna) | 149.27 | 188.84 | 194.01 | 139.19 | |||||
| Health Net | 103.00 | 135.00 | S: 140.00 Additional benefits included with Health Net Innovative plan rider
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42.00 | 114.00 | ||||
| Humana Achieve eff 8/1/2024 | 150.31 | 159.58 | 50.24 | 116.28 | |||||
| ManhattanLife | 164.58 | 165.33 | 128.33 | ||||||
| National Health Ins | 174.78 | 194.94 | 154.04 | ||||||
| Physicians Mutual | 153.77 | 166.87 | 139.07 | ||||||
| United American | 113.00 | 152.00 | 180.00 | 172.00 | 37.00 | 93.00 | 131.00 | 141.00 | |
| UHC eff 6/1/2024 | 114.29 | 159.46 | 126.05 | 106.02 | 127.97 | ||||
| Choosing a Medigap Policy | |||||||||
| Continental: Add $20 application fee. | |||||||||
| ManhattanLife: Add $25 application fee. | |||||||||
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Prepared for
Zip code: 91942 Age: 65 |
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Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
Humana Achieve rates 12% household discount Physicians Mutual rates reflect 10% You are eligible for a 10% household premium discount
if you are marriied or reside with another person age 60 or over.household discount UHC rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
UHC Plan G rates reflect $25 Welcome to Medicare discount
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