Part A Hospital Services A B 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 A B 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 A B G N
Out of Pocket Limit NA NA NA NA
Hospice coverage
Foreign Travel Emergency

Monthly Rates & Brochures A B G N
Anthem 149.29
160.46 199.55
Blue Shield eff 7/1/2024 100.00
S: 150.00
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: 167.00
 172
Continental (Aetna) 185.93 235.24 241.57 173.35
Health Net 121.00
S: 161.00
Additional benefits included with Health Net Innovative plan rider
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid
  • Routine Eye Exam - One vision exam every 12 months
  • Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months
I: 156.00
 128.00
Humana Achieve to 7/31/2024 189.23
200.91 157.16
Humana Achieve eff 8/1/2024 203.28
215.83 157.16
United American eff 5/1/2024 150.00 203.00 229.00 188.00
UHC eff 6/1/2024 132.48 184.80 150.20 148.32
Choosing a Medigap Policy
Continental: Add $20 application fee.
Prepared for
Zip code: 92672
Age: 65

Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
UHC rates based on Part B effective less than 10 years
UHC Plan G rates reflect $25 Welcome to Medicare discount
Contact us
(800) 464-4941
[email protected]
CA Ins Lic 0765088