Part A Hospital Services A B C D 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)
  • 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% 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 D 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 D 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%
Foreign Travel Emergency


Monthly Rates & Brochures A B C D G K L 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
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 eff 8/1/2024 277.05


293.02


213.64
National Health Ins 334.60


373.30


294.89
UHC eff 6/1/2024 248.13 346.80 418.90
328.86
230.19
278.14
Choosing a Medigap Policy

Prepared for Greg Bastin
Zip code: 95602
Age: 70
Spouse: 68
Select all that apply
    Automatic Checking Withdrawal Discount
    If you are new to Medicare the following monthly discounts
    are available for your first year of coverage
    • Blue Shield Plans A. F and G: $25 per month
    • Health Net All Plans: $30 per month
    • United Healthcare Plan G: $25 per month
    Welcome     to Medicare discount 2 party
    Blue ShieldYou 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 (7%)
    National Health Insurance National Health Insurance
    • You are eligible for a 7% household premium discount if you have a roommate
    • You are eligible for a 10% discount if multiple people in your household are
      covered by National Health Ins. medicare supplement policies
    household discount
    UHC/AARPYou 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 (7%)
    Contact us
    (530) 345-1162
    [email protected]
    CA Ins Lic 0687178