| 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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 | 0.00 | S: 0.00 I: Additional benefits included with Anthem Innovative plan rider
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0 | 0.00 | ||||||||
| Blue Shield eff 7/1/2024 | 0.00 | 0.00 | S: 0.00 Extra Rider
E: 0.00 |
0 | ||||||||
| Blue Shield to 6/30/2024 | 0.00 | 0.00 | S: 0.00 Extra Rider
E: 0.00 |
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| Continental (Aetna) | 200.50 | 253.57 | 355.19 | 66.56 | 260.40 | 188.51 | ||||||
| Health Net | 0.00 | 0.00 | S: 0.00 Additional benefits included with Health Net Innovative plan rider
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0.00 | S: 0.00 Additional benefits included with Health Net Innovative plan rider
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0.00 | 0.00 | |||||
| Humana Achieve to 7/31/2024 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | |||||||
| Humana Achieve eff 8/1/2024 | 0.00 | 0.00 | 0.00 | 0.00 | 0.00 | |||||||
| ManhattanLife | 222.00 | 273.92 | 223.17 | 172.42 | ||||||||
| National Health Ins | 226.71 | 296.66 | 86.85 | 252.99 | 199.80 | |||||||
| Physicians Mutual | 206.62 | 256.93 | 224.37 | 186.71 | ||||||||
| United American | 190.00 | 260.00 | 351.00 | 315.00 | 364.00 | 67.00 | 300.00 | 67.00 | 163.00 | 231.00 | 247.00 | |
| UHC to 5/31/2024 | 146.55 | 204.61 | 246.68 | 247.86 | 193.75 | 136.08 | 164.12 | |||||
| UHC eff 6/1/2024 | 163.53 | 228.11 | 275.12 | 276.50 | 216.26 | 151.68 | 183.08 | |||||
| Choosing a Medigap Policy | ||||||||||||
| Continental: Add $20 application fee. | ||||||||||||
| ManhattanLife: Add $25 application fee. | ||||||||||||
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Prepared for Mario Marroquin
Zip code: 91331 Age: 70 |
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Anthem rates reflect 10%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement member may qualify for a household discount for subscriber
UHC rates based on Part B effective less than 10 years
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