Part A Hospital Services A B C D G 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)
  • The inpatient deductible is $1632 for each benefit period
  • Days 1-60: Medicare covers 100%
  • Days 61-90: You are responsible for $408 per day
  • Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day
  • Beyond lifetime reserve: You are responsible for all costs incurred
Hospital Coinsurance		 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


3 Pints of (unreplaced) blood
Part B Services A B C D G M N
Part B Annual Deductible ($240)





Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance 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 D G M N
Out of Pocket Limit NA NA NA NA NA NA NA
Hospice coverage
Foreign Travel Emergency

Monthly Rates & Brochures A B C D G M N
Blue Shield eff 7/1/2024 240.66


S: 339.24
Extra Rider
  • Basic gym access through sliver sneakers fitness program (silversneakers.com)
  • Personal emergency response system
  • Physician consultation by phone or video through Teladoc
  • Over the counter items through CVS (Up to $100 one time use per quarter allowance)
  • The vision benefit includes coverage for exams, frames and lenses ($100 frame allowance)
  • Hearing aid benefit includes an annual hearing aid test and coverage for Vista brand mid-level and premium-level hearing aids for a low copay
  • Acupuncture and chiropractic, up to 20 combined visits per calendar year
  • Identity theft protection
E: 369.93
325.29
Continental (Aetna) 300.88 380.26

390.59
268.26
Health Net 310.00

368.00
S: 353.00
Additional benefits included with Health Net Innovative plan rider
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid
  • Routine Eye Exam - One vision exam every 12 months
  • Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months
I: 376.00
319.00
Humana Achieve to 7/31/2024 293.25


310.13
243.05
UHC eff 6/1/2024 248.13 346.80 418.90
328.86
278.14
Choosing a Medigap Policy
Continental: Add $20 application fee.
Prepared for Bastin
Zip code: 95602
Age: 70
Spouse: 68

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
Humana Achieve rates reflect $2 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
  • two or more members are enrolled under the same AARP membership number
  • and each is insured under an eligible AARP-branded supplemental insurance
    policy insured by UnitedHealthcare Insurance Company.
household discount
UHC rates reflect $2 automatic checking discount
Lowest cost plans
# Office Visits per Month

JJJJJJJJJJJJJJJJJJ

Plan Plan G Plan N
Carrier Humana Humana
Monthly Premium 310.13 243.05
  • Max monthly cost for Plan G is the premium + Medicare Part B deductible divided by 12
  • Max monthly cost for Plan N is the premium + Medicare Part B deductible divided by 12. Office Visits ($20) and Emergency Room Visits ($50) will incur additonal costs in those amounts.
  • Plan N subscribers could incur Plan B excess charges (up to 15% for any physicain provided service) which are not accounted for in this calculation
 Monthly Cost Max 		330.13 263.05 + OV
Annual Premium 3,721.56 2,916.60
  • Max annual cost for Plan G is the premium + Medicare Part B deductible
  • Max annual cost for Plan N is the premium + Medicare Part B deductible. Office Visits ($20) and Emergency Room Visits ($50) will incur additonal costs in those amounts.
  • Plan N subscribers could incur Plan B excess charges (up to 15% for any physicain provided service) which are not accounted for in this calculation
 Annual Cost Max 		3,961.56 3,156.60 + OV
Add $25 one time enrollment fee to xxManhattanLife rates jjj
Contact us
(530) 345-1162
[email protected]
CA Ins Lic 0687178