| Part A Hospital Services | A | 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 | |
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| Part B Services | A | F | G | 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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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 | F | G | N |
| Out of Pocket Limit | NA | NA | NA | NA |
| Hospice coverage | |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | F | G | N |
| Anthem | 423.22 | S: 786.42 I: Additional benefits included with Anthem Innovative plan rider
|
572.32 | 592.08 |
| Blue Shield eff 7/1/2024 | 410.00 | 832.00 | S: 678.00 Extra Rider
E: 710.00 |
520 |
| Blue Shield to 6/30/2024 | 410.00 | 768.00 | S: 626.00 Extra Rider
E: 654.00 |
492 |
| Health Net | 450.00 | S: 640.00 Additional benefits included with Health Net Innovative plan rider
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S: 511.00 Additional benefits included with Health Net Innovative plan rider
|
494.00 |
| United American | 380.00 | 822.00 | 688.00 | 576.00 |
| UHC eff 6/1/2024 | 362.50 | 613.00 | 479.50 | 406.00 |
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Prepared for
Zip code: 94903 Age: 80 Spouse: 80 |
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UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years
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