| 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) |
 |
$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 |
|
$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 |
|
|
|
$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 |
|
$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 |
|
| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
|
|
|
|
| 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 |
|
$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 |
|
| 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 |
|
$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 |
|
| Part B Services | F | F-ded | 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 | F | F-ded | G | G-ded | N |
| Out of Pocket Limit | NA | NA | NA | NA | 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 |
|
$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 |
|
| Foreign Travel Emergency | |
|
|
|
|
| Monthly Rates & Brochures | F | F-ded | G | G-ded | N |
| Anthem | S: 807.03 I: Additional benefits included with Anthem Innovative plan rider
|
579.28 | 623.26 | ||
| Blue Shield eff 7/1/2024 | 913.00 | S: 768.00 Extra Rider
E: 799.00 |
649 | ||
| Blue Shield to 6/30/2024 | 836.00 | S: 703.00 Extra Rider
E: 732.00 |
594 | ||
| Health Net | S: 733.00 Additional benefits included with Health Net Innovative plan rider
|
317.00 | S: 571.00 Additional benefits included with Health Net Innovative plan rider
|
306.00 | 590.00 |
| Humana Achieve to 7/31/2024 | 726.47 | 643.76 | 213.23 | 535.59 | |
| Humana Achieve eff 8/1/2024 | 780.63 | 691.75 | 213.23 | 535.59 | |
| Physicians Mutual | 631.60 | 550.71 | 456.98 | ||
| United American | 661.00 | 137.00 | 552.00 | 137.00 | 460.00 |
| UHC to 5/31/2024 | 628.28 | 491.11 | 416.01 | ||
| UHC eff 6/1/2024 | 700.88 | 548.18 | 464.07 |
|
Prepared for VICKI SUMNER & BENJAMIN
Zip code: 91602 Age: 74 Spouse: 88 |
|
Anthem rates reflect 5%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement for subscribermember may qualify for a household discount
Anthem spouse rates reflect 5%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement member may qualify for a household discount for co-resident
UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective 10 or more years UHC rates reflect 7% You can take 7% off your monthly premiums if
|