| 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 | 403.25 | S: 697.93 I: Additional benefits included with Anthem Innovative plan rider
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500.96 | 539.00 | |
| Blue Shield eff 7/1/2024 | 359.00 | 666.00 | S: 534.00 Extra Rider
E: 569.00 |
489 | |
| Blue Shield to 6/30/2024 | 359.00 | 616.00 | S: 494.00 Extra Rider
E: 526.00 |
452 | |
| UHC eff 6/1/2024 | 397.44 | 668.64 | 672.00 | 525.59 | 444.95 |
| Choosing a Medigap Policy | |||||
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Prepared for
Zip code: 90212 Age: 78 Spouse: 66 |
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UHC rates based on Part B effective 10 or more years UHC spousal rates based on Part B effective less than 10 years
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