| Part A Hospital Services | F | F-ded | 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) |
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$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 |
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$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 |
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$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 |
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$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 |
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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 | |
$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 |
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$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 |
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| 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 |
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$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 |
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| Part B Services | F | F-ded | G | G-ded | 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 | F | F-ded | G | G-ded | N |
| Out of Pocket Limit | NA | NA | 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 |
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$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 |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | F-ded | G | G-ded | N |
| Anthem | S: 720.02 I: Additional benefits included with Anthem Innovative plan rider
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516.82 | 556.08 | ||
| Blue Shield | 634.00 | S: 515.00 Extra Rider
E: 546.00 |
462 | ||
| Continental (Aetna) | 798.18 | 149.19 | 584.94 | 408.89 | |
| Health Net | S: 578.00 Additional benefits included with Health Net Innovative plan rider
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250.00 | S: 469.00 Additional benefits included with Health Net Innovative plan rider
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239.00 | 446.00 |
| Humana Achieve | 483.25 | 424.24 | 144.80 | 341.62 | |
| Physicians Mutual | 559.92 | 488.26 | 405.26 | ||
| United American to 4/30/2024 | 731.00 | 138.00 | 600.00 | 138.00 | 485.00 |
| United American eff 5/1/2024 | 778.00 | 150.00 | 644.00 | 150.00 | 533.00 |
| UHC to 5/31/2024 | 621.22 | 485.59 | 411.34 | ||
| UHC eff 6/1/2024 | 693.00 | 542.02 | 458.86 |
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Prepared for
Zip code: 91316 Age: 78 Spouse: 68 |
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Humana Achieve rates 12% household discount 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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