| Part A Hospital Services | A | 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 | A | 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 | |
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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 | F | G | N |
| Out of Pocket Limit | NA | NA | NA | NA |
| Hospice coverage | |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | F | G | N |
| Anthem | 323.47 | S: 559.85 I: Additional benefits included with Anthem Innovative plan rider
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401.82 | 432.34 |
| Blue Shield eff 7/1/2024 | 268.00 | 493.00 | S: 381.00 Extra Rider
E: 415.00 |
369 |
| Blue Shield to 6/30/2024 | 268.00 | 454.00 | S: 351.00 Extra Rider
E: 382.00 |
340 |
| Health Net | 317.00 | S: 451.00 Additional benefits included with Health Net Innovative plan rider
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S: 357.00 Additional benefits included with Health Net Innovative plan rider
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287.00 |
| Humana Achieve to 7/31/2024 | 379.92 | 464.59 | 403.59 | 316.01 |
| Humana Achieve eff 8/1/2024 | 408.12 | 499.15 | 433.57 | 316.01 |
| UHC to 5/31/2024 | 259.70 | 439.25 | 343.35 | 290.85 |
| UHC eff 6/1/2024 | 289.80 | 490.00 | 383.25 | 324.45 |
| Choosing a Medigap Policy | ||||
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Prepared for
Zip code: 91207 Age: 66 Spouse: 68 |
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UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years
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