| Part A Hospital Services | F | F-ded | G | G-ded | N |
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| 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 |
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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 |
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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 |
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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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| 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 |
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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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| 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 | |
$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 |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | F-ded | G | G-ded | N |
| Anthem | S: 391.94 I: Additional benefits included with Anthem Innovative plan rider
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277.67 | 292.90 | ||
| Blue Shield eff 7/1/2024 | 452.00 | S: 373.00 Extra Rider
E: 388.00 |
333 | ||
| Blue Shield to 6/30/2024 | 419.00 | S: 346.00 Extra Rider
E: 360.00 |
309 | ||
| Health Net | S: 334.00 Additional benefits included with Health Net Innovative plan rider
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144.00 | S: 298.00 Additional benefits included with Health Net Innovative plan rider
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129.00 | 256.00 |
| Humana Achieve to 7/31/2024 | 265.46 | 234.67 | 80.05 | 192.68 | |
| Humana Achieve eff 8/1/2024 | 285.23 | 252.12 | 80.05 | 192.68 | |
| Physicians Mutual | 326.43 | 284.94 | 236.86 | ||
| United American | 448.00 | 90.00 | 374.00 | 90.00 | 311.00 |
| UHC to 5/31/2024 | 309.92 | 242.27 | 205.30 | ||
| UHC eff 6/1/2024 | 353.40 | 276.44 | 234.13 | ||
| Choosing a Medigap Policy | |||||
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Prepared for THOMAS LUCZAK
Zip code: 91377 Age: 78 |
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UHC rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
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