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)
  • The inpatient deductible is $1632 for each benefit period
  • Days 1-60: Medicare covers 100%
  • Days 61-90: You are responsible for $408 per day
  • Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day
  • Beyond lifetime reserve: You are responsible for all costs incurred
Hospital Coinsurance
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 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
Additional Features F G N
Out of Pocket Limit NA NA NA
Hospice coverage
Foreign Travel Emergency
Monthly Rates & Brochures F G N
Anthem
S: 340.29
I: Additional benefits included with Anthem Innovative plan rider
  • Vision: Routine eye exam $25 copay, $100 frame allowance
  • Hearing: Hearing exam every 12 months, $750 annual allowance for hearing aids
  • Nurse help line: Speak with a Registered nurse about health related questions
  • SilverSneakers gym membership
327.61
 244.24 262.78
Blue Shield to 6/30/2024 291.00
S: 245.00
Extra Rider
  • Basic gym access through sliver sneakers fitness program (silversneakers.com)
  • Personal emergency response system
  • Physician consultation by phone or video through Teladoc
  • Over the counter items through CVS (Up to $100 one time use per quarter allowance)
  • The vision benefit includes coverage for exams, frames and lenses ($100 frame allowance)
  • Hearing aid benefit includes an annual hearing aid test and coverage for Vista brand mid-level and premium-level hearing aids for a low copay
  • Acupuncture and chiropractic, up to 20 combined visits per calendar year
  • Identity theft protection
E: 260.00
 223
Continental (Aetna) 383.68 281.22 205.08
Humana Achieve to 7/31/2024 255.91 222.63 177.01
Humana Achieve eff 8/1/2024 274.96 239.19 177.01
ManhattanLife 296.33 241.17 186.92
Physicians Mutual 274.21 239.44 199.17
UHC to 5/31/2024 266.69 208.46 176.59
Choosing a Medigap Policy
Continental: Add $20 application fee.
ManhattanLife: Add $25 application fee.
Prepared for
Zip code: 92804
Age: 72

UHC rates based on Part B effective less than 10 years
Contact us
(818) 877-6477
[email protected]
CA Ins Lic 12345678