Part A Hospital Services G G-ded
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)		 $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
  • 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		 $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
Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage
Skilled nursing facility coinsurance $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
3 Pints of (unreplaced) blood $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
Part B Services G G-ded
Part B Annual Deductible ($240)

Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance
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 G G-ded
Out of Pocket Limit NA NA
Hospice coverage $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
Foreign Travel Emergency
Monthly Rates & Brochures G G-ded
Anthem 597.22
Blue Shield eff 7/1/2024
S: 919.77
Note: Silver Sneakers gym membership is included with all Blue Shield plans.
Additonal benefits with Blue Shield Extra Rider
Foreign Travel - Not covered by Medicare
  • $250 annual deductible, 80% coverage, $50,000 lifetime max (Click the Brochure link, see page 20)
Physician Consultation by Phone or Video Through Teledoc
  • No charge (see brochure page 20)
Over-the-Counter Items through CVS
  • Up to $100 allowance per quarter (see brochure page 20)
Accupuncture and Chiropractic Services (provided by AHS provider network)
  • Up to 20 visits per year, plan pays 100%, see page 21 in brochure for details
Vision Coverage (provided by Vision Service Plan)
  • Exam every 12 months, eyeglasses every 24 months, click the brochure link for details (see page 21)
Hearing Aid Services (provided by Epic Hearing Healthcare)
  • Routine hearing exams, copayments for hearing aids, see page 23 of brochure for details
E: 953.25
Cigna 439.96
Continental (Aetna) 436.67
Health Net
S: 387.00
Additional benefits included with Health Net Innovative plan rider
  • Vision Benefits
  • Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
  • Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
  • Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
  • Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
  • Medically necessary contact Lenses - Up to $250 allowance
  • Hearing Benefits
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
    • Level 4 - You pay $1580
    • Level 3 - You pay $1125
    • Level 2 - You pay $700
    • Level 1 - You pay $0
See page 44 in Health Net brochure for detailsI: 485.00
 215.00
Humana Achieve 411.46 126.14
Physicians Mutual 486.64
United American eff 5/1/2024 0.00 0.00
UHC 318.22
United World Life 467.47 0.00
Choosing a Medigap Policy
Continental: Add $20 application fee.
Prepared for
Zip code: 92626
Age: 64

Anthem rates reflect 10%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement member may qualify for a household discount
  • For members with an original Anthem Blue Cross effective date after 2/28/2023 the discount is 10%
  • For those with original effective dates between 6/1/2010 and 2/28/2023 the discount is 5%
  • The household discount is not available to persons enrolled before 6/1/2010
household discount
for subscriber
Blue Shield rates reflect 7% You are eligible for a 7% household premium discount if you reside with another person
who is on the same Blue Shield Medicare Supplement plan, including same Dental plan.
Only one policy will be issued, the second party will be covered as a dependent.household discount
Continental rates reflect 5% You are be eligible for a 5% discount if you reside with another
person covered by Continental Life who is either
(a) your spouse;
(b) someone with whom you are in a civil union partnership;
(c) a permanent resident in your home.household discount
Humana Achieve rates 12% household discount
Physicians Mutual rates reflect 10% You are eligible for a 10% household premium discount
if you are marriied
or reside with another person age 60 or over.household discount
UHC rates based on Part B effective less than 10 years
UHC rates reflect 7% You can take 7% off your monthly premiums if
  • two or more members are enrolled under the same AARP membership number
  • and each is insured under an eligible AARP-branded supplemental insurance
    policy insured by UnitedHealthcare Insurance Company.
household discount
Contact us
(800) 464-4941
[email protected]
CA Ins Lic 0765088