| 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: 228.25 I: Additional benefits included with Anthem Innovative plan rider
|
166.1 | 171.83 | ||
| Blue Shield eff 7/1/2024 | 222.00 | S: 168.00 Extra Rider
E: 185.00 |
167 | ||
| Blue Shield to 6/30/2024 | 204.00 | S: 155.00 Extra Rider
E: 170.00 |
154 | ||
| Health Net | S: 209.00 Additional benefits included with Health Net Innovative plan rider
|
90.00 | S: 186.00 Additional benefits included with Health Net Innovative plan rider
|
76.00 | 149.00 |
| Humana Achieve to 7/31/2024 | 194.55 | 168.83 | 57.09 | 132.14 | |
| Humana Achieve eff 8/1/2024 | 208.99 | 181.34 | 57.09 | 132.14 | |
| Physicians Mutual | 211.54 | 184.86 | 153.97 | ||
| United American | 225.00 | 40.00 | 183.00 | 40.00 | 150.00 |
| UHC to 5/31/2024 | 203.68 | 159.13 | 134.84 | ||
| UHC eff 6/1/2024 | 227.13 | 177.55 | 150.42 | ||
| Choosing a Medigap Policy | |||||
|
Prepared for MARK & LORI BRITTEN
Zip code: 93306 Age: 66 |
|
UHC rates based on Part B effective less than 10 years
|