| Part A Hospital Services | F | 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) |
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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 | |
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| 3 Pints of (unreplaced) blood | |
|
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| Part B Services | F | 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 | |
|
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 | N |
| Out of Pocket Limit | NA | NA | NA |
| Hospice coverage | |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | G | N |
| Anthem | S: 611.25 I: Additional benefits included with Anthem Innovative plan rider
|
438.75 | 472.07 |
| Blue Shield eff 7/1/2024 | 592.00 | S: 485.00 Extra Rider
E: 516.00 |
454 |
| Blue Shield to 6/30/2024 | 540.00 | S: 442.00 Extra Rider
E: 471.00 |
414 |
| Continental (Aetna) | 835.41 | 612.09 | 424.00 |
| Health Net | S: 536.00 Additional benefits included with Health Net Innovative plan rider
|
S: 420.00 Additional benefits included with Health Net Innovative plan rider
|
408.00 |
| Humana Achieve | 504.39 | 440.14 | 349.74 |
| United American to 4/30/2024 | 697.00 | 571.00 | 460.00 |
| United American eff 5/1/2024 | 742.00 | 613.00 | 506.00 |
| UHC to 5/31/2024 | 514.55 | 402.21 | 340.71 |
| UHC eff 6/1/2024 | 574.00 | 448.95 | 380.07 |
|
Prepared for
Zip code: 90035 Age: 68 Spouse: 74 |
|
Anthem rates reflect 10%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement member may qualify for a household discount for subscriber
Anthem spouse rates reflect 5%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement member may qualify for a household discount for co-resident
UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years
|