| 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 | 149.29 | S: 238.36 I: Additional benefits included with Anthem Innovative plan rider
See page 21 or 22 in Anthem brochure for details |
160.46 | 199.55 | ||||||||
| Blue Shield eff 7/1/2024 | 100.00 | 210.00 | S: 150.00 Extra Rider
E: 167.00 |
172 | ||||||||
| Blue Shield to 6/30/2024 | 100.00 | 192.00 | S: 137.00 Extra Rider
E: 153.00 |
159 | ||||||||
| Continental (Aetna) | 185.93 | 235.24 | 329.70 | 61.64 | 241.57 | 173.35 | ||||||
| Health Net | 121.00 | 153.00 | S: 184.00 Additional benefits included with Health Net Innovative plan rider
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62.00 | S: 161.00 Additional benefits included with Health Net Innovative plan rider
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51.00 | 128.00 | |||||
| Humana Achieve to 7/31/2024 | 189.23 | 231.57 | 200.91 | 67.68 | 157.16 | |||||||
| Humana Achieve eff 8/1/2024 | 203.28 | 248.80 | 215.83 | 67.68 | 157.16 | |||||||
| ManhattanLife | 195.58 | 242.25 | 196.58 | 152.58 | ||||||||
| National Health Ins | 209.73 | 274.28 | 80.42 | 233.93 | 184.85 | |||||||
| Physicians Mutual | 191.86 | 238.49 | 208.32 | 173.40 | ||||||||
| United American | 150.00 | 203.00 | 273.00 | 240.00 | 284.00 | 49.00 | 229.00 | 49.00 | 123.00 | 175.00 | 188.00 | |
| UHC to 5/31/2024 | 118.72 | 165.76 | 199.84 | 200.80 | 131.96 | 110.24 | 132.96 | |||||
| UHC eff 6/1/2024 | 132.48 | 184.80 | 222.88 | 224.00 | 150.20 | 122.88 | 148.32 | |||||
| Choosing a Medigap Policy | ||||||||||||
| Continental: Add $20 application fee. | ||||||||||||
| ManhattanLife: Add $25 application fee. | ||||||||||||
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Prepared for
Zip code: 92660 Age: 65 |
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Anthem Plan F rates reflect $20.00 Welcome to Medicare discount
Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield Plan F rates reflect $25 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
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