| 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 | 247.89 | S: 429.05 I: Additional benefits included with Anthem Innovative plan rider
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307.98 | 331.37 | ||||||||
| Blue Shield | 236.00 | 408.00 | S: 337.00 Extra Rider
E: 352.00 |
295 | ||||||||
| Continental (Aetna) | 264.64 | 334.95 | 468.98 | 87.71 | 343.70 | 256.23 | ||||||
| Health Net | 238.00 | 314.00 | S: 341.00 Additional benefits included with Health Net Innovative plan rider
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148.00 | S: 303.00 Additional benefits included with Health Net Innovative plan rider
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137.00 | 270.00 | |||||
| Humana Achieve | 253.27 | 316.13 | 279.41 | 95.06 | 229.35 | |||||||
| ManhattanLife | 278.67 | 349.25 | 279.92 | 237.50 | ||||||||
| National Health Ins | 302.01 | 395.39 | 115.76 | 337.11 | 266.15 | |||||||
| Physicians Mutual | 228.21 | 294.29 | 256.95 | 213.67 | ||||||||
| United American to 4/30/2024 | 211.00 | 299.00 | 412.00 | 374.00 | 421.00 | 83.00 | 348.00 | 83.00 | 185.00 | 261.00 | 283.00 | |
| United American eff 5/1/2024 | 217.00 | 306.00 | 433.00 | 393.00 | 448.00 | 90.00 | 374.00 | 90.00 | 185.00 | 261.00 | 311.00 | |
| UHC to 5/31/2024 | 172.52 | 240.87 | 290.39 | 291.79 | 228.08 | 160.19 | 193.21 | |||||
| UHC eff 6/1/2024 | 192.51 | 268.54 | 323.87 | 325.50 | 254.59 | 178.56 | 215.53 |
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Prepared for
Zip code: 92804 Age: 78 |
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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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