| Part A Hospital Services | C | F | 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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| 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 | C | 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 | C | 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 | C | F | G | N |
| Anthem | S: 429.05 I: Additional benefits included with Anthem Innovative plan rider
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307.98 | 331.37 | |
| Blue Shield eff 7/1/2024 | 440.00 | S: 364.00 Extra Rider
E: 380.00 |
318 | |
| Blue Shield to 6/30/2024 | 408.00 | S: 337.00 Extra Rider
E: 352.00 |
295 | |
| Health Net | S: 341.00 Additional benefits included with Health Net Innovative plan rider
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S: 303.00 Additional benefits included with Health Net Innovative plan rider
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270.00 | |
| Humana Achieve to 7/31/2024 | 316.13 | 279.41 | 229.35 | |
| Humana Achieve eff 8/1/2024 | 339.70 | 300.22 | 229.35 | |
| UHC to 5/31/2024 | 390.31 | 392.18 | 306.56 | 259.68 |
| UHC eff 6/1/2024 | 435.31 | 437.50 | 342.18 | 289.68 |
| Choosing a Medigap Policy | ||||
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Prepared for
Zip code: 92782 Age: 78 |
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UHC rates based on Part B effective 10 or more years
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