| 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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$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: 306.26 I: Additional benefits included with Anthem Innovative plan rider
|
219.82 | 236.50 | ||
| Blue Shield eff 7/1/2024 | 305.00 | S: 256.00 Extra Rider
E: 273.00 |
240 | ||
| Blue Shield to 6/30/2024 | 283.00 | S: 238.00 Extra Rider
E: 253.00 |
223 | ||
| Health Net | S: 278.00 Additional benefits included with Health Net Innovative plan rider
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119.00 | S: 247.00 Additional benefits included with Health Net Innovative plan rider
|
108.00 | 213.00 |
| Humana Achieve to 7/31/2024 | 255.91 | 222.63 | 78.69 | 177.01 | |
| Humana Achieve eff 8/1/2024 | 274.96 | 239.19 | 78.69 | 177.01 | |
| Physicians Mutual | 274.21 | 239.44 | 199.17 | ||
| United American | 390.00 | 73.00 | 323.00 | 73.00 | 267.00 |
| UHC to 5/31/2024 | 266.69 | 208.46 | 176.59 | ||
| UHC eff 6/1/2024 | 297.50 | 232.69 | 196.99 | ||
| Choosing a Medigap Policy | |||||
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Prepared for BONITA LELAND (BONNIE)
Zip code: 91325 Age: 72 |
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Anthem rates reflect 10%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement member may qualify for a household discount for subscriber
UHC rates based on Part B effective less than 10 years
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