| Part A Hospital Services | A | B | C | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|
| 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) |
 |
|
|
|
|
|
|
|
|
|
|
|
|
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% |
|
|||
| 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% |
|
|
| Part B Services | A | B | C | 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 |
| 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 |
|
|||||||
| Additional Features | A | B | C | G | K | L | M | N |
| Out of Pocket Limit | 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% |
|
|
| Foreign Travel Emergency | |
|
|
|
|
|||
| Monthly Rates & Brochures | A | B | C | G | K | L | M | N |
| Anthem | 116.04 | 132.63 | 163.15 | |||||
| Blue Shield eff 7/1/2024 | 82.00 | S: 119.00 Extra Rider
E: 135.00 |
141 | |||||
| Health Net | 92.00 | S: 125.00 Additional benefits included with Health Net Innovative plan rider
|
94.00 | |||||
| Choosing a Medigap Policy | ||||||||
|
Prepared for f
Zip code: 95602 Age: 65 |
|
Anthem rates reflect $2 automatic checking discount
Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield rates reflect $3 automatic checking discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
|