| Part A Hospital Services | F | F-ded | G | 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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$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 |
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| 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 |
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| 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 |
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| Part B Services | F | F-ded | G | 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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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 | F-ded | G | N |
| Out of Pocket Limit | NA | 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 & Brochures | F | F-ded | G | N |
| Anthem | S: 340.29 I: Additional benefits included with Anthem Innovative plan rider
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244.24 | 262.78 | |
| Blue Shield eff 7/1/2024 | 313.00 | S: 264.00 Extra Rider
E: 280.00 |
240 | |
| Blue Shield to 6/30/2024 | 291.00 | S: 245.00 Extra Rider
E: 260.00 |
223 | |
| Continental (Aetna) | 430.83 | 80.72 | 315.79 | 230.32 |
| Health Net | S: 278.00 Additional benefits included with Health Net Innovative plan rider
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119.00 | S: 247.00 Additional benefits included with Health Net Innovative plan rider
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213.00 |
| Humana Achieve | 255.91 | 222.63 | 177.01 | |
| ManhattanLife | 270.58 | 220.25 | 186.92 | |
| National Health Ins | 320.63 | 93.89 | 273.33 | 215.84 |
| Physicians Mutual | 274.21 | 239.44 | 199.17 | |
| United American to 4/30/2024 | 366.00 | 67.00 | 300.00 | 243.00 |
| United American eff 5/1/2024 | 390.00 | 73.00 | 323.00 | 267.00 |
| UHC to 5/31/2024 | 244.73 | 191.30 | 162.05 | |
| UHC eff 6/1/2024 | 273.00 | 213.53 | 180.77 |
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Prepared for
Zip code: 92653 Age: 72 |
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UHC rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
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