| 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: 377.45 I: Additional benefits included with Anthem Innovative plan rider
|
270.92 | 291.50 | ||
| Blue Shield eff 7/1/2024 | 380.00 | S: 318.00 Extra Rider
E: 335.00 |
292 | ||
| Blue Shield to 6/30/2024 | 353.00 | S: 296.00 Extra Rider
E: 312.00 |
272 | ||
| Health Net | S: 320.00 Additional benefits included with Health Net Innovative plan rider
|
138.00 | S: 286.00 Additional benefits included with Health Net Innovative plan rider
|
127.00 | 250.00 |
| Humana Achieve to 7/31/2024 | 295.72 | 260.59 | 89.89 | 211.97 | |
| Humana Achieve eff 8/1/2024 | 317.74 | 279.98 | 89.89 | 211.97 | |
| Physicians Mutual | 307.98 | 268.87 | 223.56 | ||
| United American | 431.00 | 87.00 | 359.00 | 87.00 | 297.00 |
| UHC to 5/31/2024 | 282.38 | 220.73 | 186.98 | ||
| UHC eff 6/1/2024 | 315.00 | 246.38 | 208.58 | ||
| Choosing a Medigap Policy | |||||
|
Prepared for
Zip code: 90025 Age: 76 |
|
Anthem rates reflect 5%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement for subscribermember may qualify for a household discount
UHC rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
|