| Part A Hospital Services | F | G-ded | 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) |
 |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 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 | |
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| Skilled nursing facility coinsurance | |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
|
| 3 Pints of (unreplaced) blood | |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
|
| Part B Services | F | G-ded | N |
| Part B Annual Deductible ($240) | |
||
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
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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 | F | G-ded | N |
| Out of Pocket Limit | NA | NA | NA |
| Hospice coverage | |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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| Foreign Travel Emergency | |
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| Monthly Rates | F | G-ded | N |
| Anthem | S: 314.76 I: Additional benefits included with Anthem Innovative plan rider
|
243.07 | |
| Blue Shield | 265.00 | 197 | |
| Continental (Aetna) | 355.19 | 188.51 | |
| Health Net | S: 257.00 Additional benefits included with Health Net Innovative plan rider
|
98.00 | 194.00 |
| Humana Achieve | 240.46 | 73.65 | 163.14 |
| ManhattanLife | 250.25 | 172.42 | |
| National Health Ins | 296.66 | 199.80 | |
| Physicians Mutual | 256.93 | 186.71 | |
| United American | 342.00 | 61.00 | 225.00 |
| UHC | 247.86 | 164.12 |
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Prepared for
Zip code: 92804 Age: 70 |
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UHC rates based on Part B effective less than 10 years
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