| Part A Hospital Services | A | B | C | F | G | 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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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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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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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 | F | G | 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 | F | G | K | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
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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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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | B | C | F | G | K | L | M | N |
| Anthem | 264.04 | S: 492.37 I: Additional benefits included with Anthem Innovative plan rider
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357.8 | 370.22 | |||||
| Blue Shield eff 7/1/2024 | 225.78 | 407.13 | S: 318.78 Extra Rider
E: 350.40 |
309.48 | |||||
| Blue Shield to 6/30/2024 | 225.78 | 376.44 | S: 294.60 Extra Rider
E: 324.36 |
286.23 | |||||
| Continental (Aetna) | 289.55 | 366.19 | 513.13 | 376.10 | 257.74 | ||||
| Health Net | 310.00 | S: 439.00 Additional benefits included with Health Net Innovative plan rider
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S: 349.00 Additional benefits included with Health Net Innovative plan rider
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319.00 | |||||
| United American to 4/30/2024 | 299.00 | 405.00 | 533.00 | 544.00 | 442.00 | 259.00 | 366.00 | 355.00 | |
| United American eff 5/1/2024 | 305.00 | 415.00 | 559.00 | 580.00 | 476.00 | 259.00 | 366.00 | 390.00 | |
| UHC to 5/31/2024 | 212.17 | 296.98 | 358.69 | 360.34 | 281.14 | 196.99 | 237.91 | ||
| UHC eff 6/1/2024 | 237.25 | 331.63 | 400.60 | 402.58 | 314.47 | 220.09 | 265.96 |
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Prepared for Dave Dalton
Zip code: 95928 Age: 67 Spouse: 69 |
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Anthem rates reflect $2 automatic checking discount
Blue Shield rates reflect 7% You are eligible for a 7% household premium discount if you reside with another person
who is on the same Blue Shield Medicare Supplement plan, including same Dental plan. Only one policy will be issued, the second party will be covered as a dependent.household discount Blue Shield rates reflect $3 automatic checking discount
UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
UHC rates reflect $2 automatic checking discount
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