| Part A Hospital Services | F | F-ded | K | 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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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 | |
$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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| 3 Pints of (unreplaced) blood | |
$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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| Part B Services | F | F-ded | K | 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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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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 | K | N |
| Out of Pocket Limit | NA | NA | $5120 | NA |
| Hospice coverage | |
$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | F-ded | K | N |
| Anthem | S: 236.01 I: Additional benefits included with Anthem Innovative plan rider
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176.38 | ||
| Blue Shield eff 7/1/2024 | 241.00 | 177 | ||
| Continental (Aetna) | 240.65 | 44.98 | 126.53 | |
| Health Net | S: 209.00 Additional benefits included with Health Net Innovative plan rider
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90.00 | 149.00 | |
| Humana Achieve to 7/31/2024 | 194.55 | 132.14 | ||
| ManhattanLife | 186.08 | 128.33 | ||
| United American eff 5/1/2024 | 213.00 | 37.00 | 93.00 | 141.00 |
| UHC eff 6/1/2024 | 243.20 | 161.12 |
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Prepared for Bennett
Zip code: 93065 Age: 65 |
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UHC rates based on Part B effective less than 10 years
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