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 | |||||||||
Skilled nursing facility coinsurance | 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 | 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) | |||||||||
Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | 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% |
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 | A | B | C | F | G | K | L | M | N |
Out of Pocket Limit | NA | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
Hospice coverage | 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 | |||||||||
Monthly Rates & Brochures | A | B | C | F | G | K | L | M | N |
Anthem | 118.04 | S: 199.32 I: Additional benefits included with Anthem Innovative plan rider
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134.63 | 165.15 | |||||
Blue Shield eff 7/1/2024 | 85.00 | 172.00 | S: 122.00 Extra Rider
E: 138.00 |
144 | |||||
Continental (Aetna) | 128.95 | 163.10 | 228.66 | 167.52 | 120.20 | ||||
Health Net | 103.00 | S: 160.00 Additional benefits included with Health Net Innovative plan rider
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S: 140.00 Additional benefits included with Health Net Innovative plan rider
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105.00 | |||||
United American to 4/30/2024 | 128.00 | 173.00 | 228.00 | 233.00 | 187.00 | 108.00 | 153.00 | 150.00 | |
United American eff 5/1/2024 | 131.00 | 177.00 | 239.00 | 248.00 | 201.00 | 108.00 | 153.00 | 165.00 | |
UHC eff 6/1/2024 | 116.00 | 161.76 | 195.20 | 196.16 | 128.44 | 107.68 | 129.92 |
Prepared for Kelli Lotti
Zip code: 95927 Age: 65 |
Anthem Plan F rates reflect $20.00 Welcome to Medicare discount
Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield Plan F rates reflect $25 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
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