| 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: 336.10 I: Additional benefits included with Anthem Innovative plan rider
|
241.25 | 259.56 | ||
| Blue Shield eff 7/1/2024 | 323.00 | S: 270.00 Extra Rider
E: 286.00 |
257 | ||
| Blue Shield to 6/30/2024 | 296.00 | S: 247.00 Extra Rider
E: 262.00 |
235 | ||
| Health Net | S: 299.00 Additional benefits included with Health Net Innovative plan rider
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129.00 | S: 267.00 Additional benefits included with Health Net Innovative plan rider
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118.00 | 232.00 |
| Humana Achieve | 263.64 | 230.05 | 81.22 | 183.96 | |
| Physicians Mutual | 282.26 | 246.49 | 205.00 | ||
| United American to 4/30/2024 | 377.00 | 71.00 | 310.00 | 71.00 | 251.00 |
| United American eff 5/1/2024 | 402.00 | 77.00 | 334.00 | 77.00 | 276.00 |
| UHC to 5/31/2024 | 276.10 | 215.82 | 182.82 | ||
| UHC eff 6/1/2024 | 308.00 | 240.90 | 203.94 |
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Prepared for MARK GREENSTADT
Zip code: 91311 Age: 73 |
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Anthem rates reflect 5%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement for subscribermember may qualify for a household discount
UHC rates based on Part B effective less than 10 years
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