| Part A Hospital Services | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
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| 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) |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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 | |
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| Skilled nursing facility coinsurance | |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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% |
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| 3 Pints of (unreplaced) blood | |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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% |
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| Part B Services | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Part B Annual Deductible ($240) | |
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| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
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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% |
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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 |
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| Additional Features | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
| Hospice coverage | |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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% |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Anthem | 181.84 | S: 314.76 I: Additional benefits included with Anthem Innovative plan rider
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225.92 | 243.07 | ||||||||
| Blue Shield | 156.00 | 265.00 | S: 218.00 Extra Rider
E: 233.00 |
197 | ||||||||
| Continental (Aetna) | 200.50 | 253.57 | 355.19 | 66.56 | 260.40 | 188.51 | ||||||
| Health Net | 180.00 | 225.00 | S: 257.00 Additional benefits included with Health Net Innovative plan rider
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112.00 | S: 229.00 Additional benefits included with Health Net Innovative plan rider
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98.00 | 194.00 | |||||
| Humana Achieve | 197.51 | 240.46 | 207.79 | 73.65 | 163.14 | |||||||
| ManhattanLife | 202.75 | 250.25 | 203.83 | 172.42 | ||||||||
| National Health Ins | 226.71 | 296.66 | 86.85 | 252.99 | 199.80 | |||||||
| Physicians Mutual | 186.46 | 231.74 | 202.43 | 168.54 | ||||||||
| United American to 4/30/2024 | 185.00 | 253.00 | 335.00 | 300.00 | 342.00 | 61.00 | 279.00 | 61.00 | 163.00 | 231.00 | 225.00 | |
| United American eff 5/1/2024 | 190.00 | 260.00 | 351.00 | 315.00 | 364.00 | 67.00 | 300.00 | 67.00 | 163.00 | 231.00 | 247.00 | |
| UHC to 5/31/2024 | 133.56 | 186.48 | 224.82 | 225.90 | 176.58 | 124.02 | 149.58 | |||||
| UHC eff 6/1/2024 | 149.04 | 207.90 | 250.74 | 252.00 | 197.10 | 138.24 | 166.86 |
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Prepared for
Zip code: 92804 Age: 70 |
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Physicians Mutual rates reflect 10% You are eligible for a 10% household premium discount
if you are marriied or reside with another person age 60 or over.household discount UHC rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
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