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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
Blue Shield eff 7/1/2024 CKHH	S: 171.00 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: 188.00		168
Humana Achieve to 7/31/2024CKHH	200.91	67.68	157.16
Humana Achieve eff 8/1/2024CKHH	215.83	67.68	157.16

Part A Hospital Services

G-ded

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-ded

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-ded

Out of Pocket Limit

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-ded

Blue Shield eff 7/1/2024 CKHH

S: 171.00

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: 188.00

168

Humana Achieve to 7/31/2024CKHH

200.91

67.68

157.16

Humana Achieve eff 8/1/2024CKHH

215.83

67.68

157.16

Select all that apply

Humana Achieve $2 per month

Automatic Checking Withdrawal Discount

If you are new to Medicare the following monthly discounts
are available for your first year of coverage

Blue Shield Plans A. F and G: $25 per month

Welcome to Medicare discount 2 party

Anthem rates reflect $2 automatic checking discount.

Blue Shield Plan G rates reflect $25 Welcome to Medicare discount.

Blue Shield Plan G rates reflect $50 2 party Welcome to Medicare discount.

Blue Shield rates reflect $3 automatic checking discount.

Blue ShieldYou are eligible for a 7% household premium discount

if you reside with another person who is on the same Blue Shield Medicare Supplement plan
including same Dental plan.

Only one policy will be issued, the second party will be covered as a dependent. household discount (7%)

Continental Life You are be eligible for a 5% discount if you reside with another
person covered by Continental Life who is either
(a) your spouse;
(b) someone with whom you are in a civil union partnership;
(c) a permanent resident in your home.5% household discount

Humana Achieve rates reflect $2 automatic checking discount.

Humana AchieveHumana Achieve offers a 12% household premium discount

if you reside with your spouse or domestic partner
or if you have resided with one to three adults for the past 12 months.

household discount (12%)

Physicians Mutual rates reflect $5 automatic checking discount.

UHC Plan G rates reflect $25 Welcome to Medicare discount.

UHC Plan G rates reflect $50 2 party Welcome to Medicare discount.

United Healthcare rates reflect $2 automatic checking discount.