| Part A Hospital Services | A | B | C | D | G | G-ded | 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) |
 |
|
|
|
$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
|
|
|
|
|
|
|
|
|
|
$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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 | |
|
|
$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
|
|||
| 3 Pints of (unreplaced) blood | |
|
|
|
|
$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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 | G-ded | 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 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 | G-ded | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | $2560 | NA | NA |
| Hospice coverage | |
|
|
|
|
$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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 | G-ded | L | M | N |
| Anthem | 118.04 | 134.63 | 165.15 | ||||||
| Blue Shield | 85.00 | S: 122.00 Note: Silver Sneakers gym membership is included with all Blue Shield plans. Additonal benefits with Blue Shield Extra RiderForeign Travel - Not covered by Medicare
Physician Consultation by Phone or Video Through Teledoc
Over-the-Counter Items through CVS
Accupuncture and Chiropractic Services (provided by AHS provider network)
Vision Coverage (provided by Vision Service Plan)
Hearing Aid Services (provided by Epic Hearing Healthcare)
E: 138.00 |
144 | ||||||
| Cigna | 149.10 | 160.66 | 114.35 | ||||||
| Continental (Aetna) | 128.95 | 163.10 | 167.52 | 120.20 | |||||
| Health Net | 103.00 | 126.00 | S: 140.00 Additional benefits included with Health Net Innovative plan rider
|
38.00 | 105.00 | ||||
| Humana Achieve | 154.58 | 164.09 | 51.79 | 119.62 | |||||
| National Health Ins | 160.79 | 179.34 | 141.71 | ||||||
| UHC | 116.00 | 161.76 | 195.20 | 128.44 | 107.68 | 129.92 | |||
| Choosing a Medigap Policy | |||||||||
| Continental: Add $20 application fee. | |||||||||
|
Prepared for Art
Zip code: 95928 Age: 65 |
|
Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
UHC rates based on Part B effective less than 10 years UHC Plan G rates reflect $25 Welcome to Medicare discount
|