Part A Hospital Services G G-ded 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)		 $2700 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year
After that coverage is 100%
after
ded
  • The inpatient deductible is $1632 for each benefit period
  • Days 1-60: Medicare covers 100%
  • Days 61-90: You are responsible for $408 per day
  • Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day
  • Beyond lifetime reserve: You are responsible for all costs incurred
Hospital Coinsurance		 $2700 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year
After that coverage is 100%
after
ded
Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage
Skilled nursing facility coinsurance $2700 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year
After that coverage is 100%
after
ded
3 Pints of (unreplaced) blood $2700 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year
After that coverage is 100%
after
ded
Part B Services G G-ded N
Part B Annual Deductible ($240)


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
Additional Features G G-ded N
Out of Pocket Limit NA NA NA
Hospice coverage $2700 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year
After that coverage is 100%
after
ded
Foreign Travel Emergency
Monthly Rates & Brochures G G-ded N
Anthem 160.46
199.55
Blue Shield
S: 133.00
Extra Rider
  • Basic gym access through sliver sneakers fitness program (silversneakers.com)
  • Personal emergency response system
  • Physician consultation by phone or video through Teladoc
  • Over the counter items through CVS (Up to $100 one time use per quarter allowance)
  • The vision benefit includes coverage for exams, frames and lenses ($100 frame allowance)
  • Hearing aid benefit includes an annual hearing aid test and coverage for Vista brand mid-level and premium-level hearing aids for a low copay
  • Acupuncture and chiropractic, up to 20 combined visits per calendar year
  • Identity theft protection
E: 149.00
155
Continental (Aetna) 215.16
154.35
Health Net
S: 161.00
Additional benefits included with Health Net Innovative plan rider
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid
  • Routine Eye Exam - One vision exam every 12 months
  • Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months
I: 131.00
 38.00 105.00
Humana Achieve 176.80 59.56 138.30
ManhattanLife 179.58
152.58
National Health Ins 233.93
184.85
Physicians Mutual 208.32
173.40
United American to 4/30/2024 213.00 45.00 171.00
United American eff 5/1/2024 229.00 49.00 188.00
UHC 131.96
132.96
Prepared for
Zip code: 91326
Age: 65

Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
Humana Achieve rates 12% household discount
UHC rates based on Part B effective less than 10 years
UHC Plan G rates reflect $25 Welcome to Medicare discount
Lowest cost plans
# Office Visits per Month
Plan Plan G Plan N
Carrier Health Net Health Net
Monthly Premium 131.00 105.00
  • Max monthly cost for Plan G is the premium + Medicare Part B deductible divided by 12
  • Max monthly cost for Plan N is the premium + Medicare Part B deductible divided by 12. Office Visits ($20) and Emergency Room Visits ($50) will incur additonal costs in those amounts.
  • Plan N subscribers could incur Plan B excess charges (up to 15% for any physicain provided service) which are not accounted for in this calculation
 Monthly Cost Max 		151.00 125.00 + OV
Annual Premium 1,572.00 1,260.00
  • Max annual cost for Plan G is the premium + Medicare Part B deductible
  • Max annual cost for Plan N is the premium + Medicare Part B deductible. Office Visits ($20) and Emergency Room Visits ($50) will incur additonal costs in those amounts.
  • Plan N subscribers could incur Plan B excess charges (up to 15% for any physicain provided service) which are not accounted for in this calculation
 Annual Cost Max 		1,812.00 1,500.00 + OV
Contact us
(818) 888-0880
[email protected]
CA Ins Lic OA2225