| Part A Hospital Services | F | G | 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) |
 |
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| 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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| 3 Pints of (unreplaced) blood | |
|
|
| Part B Services | F | G | N |
| Part B Annual Deductible ($240) | |
||
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
|
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 | F | G | N |
| Out of Pocket Limit | NA | NA | NA |
| Hospice coverage | |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | G | N |
| Anthem | S: 629.52 I: Additional benefits included with Anthem Innovative plan rider
|
451.84 | 486.14 |
| Blue Shield eff 7/1/2024 | 566.00 | S: 466.00 Extra Rider
E: 498.00 |
422 |
| Blue Shield to 6/30/2024 | 530.00 | S: 436.00 Extra Rider
E: 466.00 |
394 |
| Continental (Aetna) | 710.38 | 520.80 | 358.17 |
| Health Net | S: 514.00 Additional benefits included with Health Net Innovative plan rider
|
S: 409.00 Additional benefits included with Health Net Innovative plan rider
|
388.00 |
| Humana Achieve | 480.92 | 415.58 | 326.28 |
| ManhattanLife | 500.50 | 407.66 | 344.84 |
| National Health Ins | 593.31 | 505.98 | 399.60 |
| Physicians Mutual | 508.86 | 443.74 | 368.42 |
| United American to 4/30/2024 | 684.00 | 558.00 | 450.00 |
| United American eff 5/1/2024 | 728.00 | 600.00 | 494.00 |
| UHC to 5/31/2024 | 495.73 | 387.50 | 328.25 |
| UHC eff 6/1/2024 | 553.00 | 432.53 | 366.17 |
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Prepared for
Zip code: 92804 Age: 70 Spouse: 70 |
|
UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years
|