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Part A Hospital Services | A | 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 | A | 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 | A | C | F | G | N |
Out of Pocket Limit | NA | NA | NA | NA | NA |
Hospice coverage | ![]() |
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Foreign Travel Emergency | ![]() |
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Monthly Rates & Brochures | A | C | F | G | N |
Anthem | 149.29 | S: 258.36 I: Additional benefits included with Anthem Innovative plan rider
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185.46 | 199.55 | |
Blue Shield eff 7/1/2024 | 125.00 | 227.00 | S: 171.00 Extra Rider
E: 188.00 |
168 | |
Blue Shield to 6/30/2024 | 1,251.00 | 210.00 | S: 158.00 Extra Rider
E: 174.00 |
155 | |
UHC eff 6/1/2024 | 132.48 | 222.88 | 224.00 | 175.20 | 148.32 |
Choosing a Medigap Policy |
Prepared for
Zip code: 91356 Age: 65 |
UHC rates based on Part B effective less than 10 years
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