| 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: 915.29 I: Additional benefits included with Anthem Innovative plan rider
|
656.98 | 706.86 | ||
| Blue Shield eff 7/1/2024 | 1,154.00 | S: 970.00 Extra Rider
E: 1,002.00 |
770 | ||
| Blue Shield to 6/30/2024 | 1,064.00 | S: 894.00 Extra Rider
E: 924.00 |
710 | ||
| Health Net | S: 868.00 Additional benefits included with Health Net Innovative plan rider
|
376.00 | S: 691.00 Additional benefits included with Health Net Innovative plan rider
|
362.00 | 688.00 |
| Humana Achieve to 7/31/2024 | 825.68 | 736.26 | 238.28 | 620.24 | |
| Humana Achieve eff 8/1/2024 | 887.30 | 791.18 | 238.28 | 620.24 | |
| Physicians Mutual | 741.33 | 646.26 | 536.14 | ||
| United American | 940.00 | 204.00 | 786.00 | 204.00 | 658.00 |
| UHC to 5/31/2024 | 729.45 | 570.20 | 483.00 | ||
| UHC eff 6/1/2024 | 813.75 | 636.45 | 538.80 | ||
| Choosing a Medigap Policy | |||||
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Prepared for
Zip code: 90064 Age: 85 Spouse: 85 |
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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 10 or more 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
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