| Part A Hospital Services | F | G |
|---|---|---|
| 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) |
 |
|
|
|
|
| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
|
| Skilled nursing facility coinsurance | |
|
| 3 Pints of (unreplaced) blood | |
|
| Part B Services | F | G |
| Part B Annual Deductible ($240) | |
|
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
|
| 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 | F | G |
| Out of Pocket Limit | NA | NA |
| Hospice coverage | |
|
| Foreign Travel Emergency | |
|
| Monthly Rates & Brochures | F | G |
| Anthem | S: 579.65 I: Additional benefits included with Anthem Innovative plan rider
|
404.86 |
| Blue Shield eff 7/1/2024 | 527.00 | S: 423.00 Extra Rider
E: 456.00 |
| Blue Shield to 6/30/2024 | 490.00 | S: 393.00 Extra Rider
E: 424.00 |
| Continental (Aetna) | 697.39 | 511.13 |
| Health Net | S: 484.00 Additional benefits included with Health Net Innovative plan rider
|
S: 379.00 Additional benefits included with Health Net Innovative plan rider
|
| Humana Achieve | 475.60 | 409.93 |
| ManhattanLife | 490.08 | 399.16 |
| National Health Ins | 581.88 | 496.20 |
| Physicians Mutual | 494.75 | 430.83 |
| United American to 4/30/2024 | 668.00 | 544.00 |
| United American eff 5/1/2024 | 711.00 | 585.00 |
| UHC to 5/31/2024 | 484.31 | 353.14 |
| UHC eff 6/1/2024 | 540.50 | 397.31 |
|
Prepared for
Zip code: 92804 Age: 70 Spouse: 69 |
|
Anthem rates reflect 5%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement for subscribermember may qualify for a household discount
Anthem rates reflect $2 automatic checking discount
Anthem Plan F rates reflect $20.00 Welcome to Medicare discount
Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield rates reflect $3 automatic checking discount
Blue Shield Plan F rates reflect $25 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
Humana Achieve rates reflect $2 automatic checking discount
Physicians Mutual rates reflect $5 automatic checking discount
UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years UHC Plan G rates reflect $25 Welcome to Medicare discount
UHC rates reflect $2 automatic checking discount
|