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Part A Hospital Services	A	B	C	G	K	L	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%
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	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	N
Out of Pocket Limit	NA	NA	NA	NA	$5120	$2560	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	N
Anthem CKHH	118.04			134.63			165.15
Blue Shield eff 7/1/2024 CKHH	83.00			S: 122.00 Note: Silver Sneakers gym membership is included with all Blue Shield plans. Additonal benefits with Blue Shield Extra Rider Foreign Travel - Not covered by Medicare $250 annual deductible, 80% coverage, $50,000 lifetime max (Click the Brochure link, see page 20) Physician Consultation by Phone or Video Through Teledoc No charge (see brochure page 20) Over-the-Counter Items through CVS Up to $100 allowance per quarter (see brochure page 20) Accupuncture and Chiropractic Services (provided by AHS provider network) Up to 20 visits per year, plan pays 100%, see page 21 in brochure for details Vision Coverage (provided by Vision Service Plan) Exam every 12 months, eyeglasses every 24 months, click the brochure link for details (see page 21) Hearing Aid Services (provided by Epic Hearing Healthcare) Routine hearing exams, copayments for hearing aids, see page 23 of brochure for details E: 139.00			866
Cigna HH	149.10			160.66			114.35
Continental (Aetna) HH	128.95	163.10		167.52			120.20
Health Net	92.00			S: 125.00 Additional benefits included with Health Net Innovative plan rider Vision Benefits Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance Medically necessary contact Lenses - Up to $250 allowance Hearing Benefits Routine Hearing Exam - One hearing exam every 12 months Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions Level 4 - You pay $1580 Level 3 - You pay $1125 Level 2 - You pay $700 Level 1 - You pay $0 See page 44 in Health Net brochure for detailsI: 118.00			94.00
Humana Achieve CKHH	154.58			164.09			119.62
UHC CKHH	116.00	161.76	195.20	128.44		107.68	129.92
Choosing a Medigap Policy
Continental: Add $20 application fee.

Part A Hospital Services

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%

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

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

Out of Pocket Limit

$5120

$2560

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

Anthem CKHH

118.04

134.63

165.15

Blue Shield eff 7/1/2024 CKHH

83.00

S: 122.00

Note: Silver Sneakers gym membership is included with all Blue Shield plans.

Additonal benefits with Blue Shield Extra Rider

Foreign Travel - Not covered by Medicare

$250 annual deductible, 80% coverage, $50,000 lifetime max (Click the Brochure link, see page 20)

Physician Consultation by Phone or Video Through Teledoc

No charge (see brochure page 20)

Over-the-Counter Items through CVS

Up to $100 allowance per quarter (see brochure page 20)

Accupuncture and Chiropractic Services (provided by AHS provider network)

Up to 20 visits per year, plan pays 100%, see page 21 in brochure for details

Vision Coverage (provided by Vision Service Plan)

Exam every 12 months, eyeglasses every 24 months, click the brochure link for details (see page 21)

Hearing Aid Services (provided by Epic Hearing Healthcare)

Routine hearing exams, copayments for hearing aids, see page 23 of brochure for details

E: 139.00

866

Cigna HH

149.10

160.66

114.35

Continental (Aetna) HH

128.95

163.10

167.52

120.20

Health Net

92.00

S: 125.00
Additional benefits included with Health Net Innovative plan rider

Vision Benefits
Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
Medically necessary contact Lenses - Up to $250 allowance
Hearing Benefits
Routine Hearing Exam - One hearing exam every 12 months
Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
- Level 4 - You pay $1580
- Level 3 - You pay $1125
- Level 2 - You pay $700
- Level 1 - You pay $0

See page 44 in Health Net brochure for detailsI: 118.00

94.00

Humana Achieve CKHH

154.58

164.09

119.62

UHC CKHH

116.00

161.76

195.20

128.44

107.68

129.92

Choosing a Medigap Policy

Continental: Add $20 application fee.