| 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: 327.28 I: Additional benefits included with Anthem Innovative plan rider
|
234.93 | 252.76 | ||
| Blue Shield eff 7/1/2024 | 286.00 | S: 239.00 Extra Rider
E: 256.00 |
223 | ||
| Blue Shield to 6/30/2024 | 269.00 | S: 224.00 Extra Rider
E: 240.00 |
209 | ||
| 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
|
92.00 | 183.00 |
| Humana Achieve to 7/31/2024 | 248.19 | 215.21 | 76.16 | 170.07 | |
| Humana Achieve eff 8/1/2024 | 266.65 | 231.20 | 76.16 | 170.07 | |
| Physicians Mutual | 265.74 | 232.07 | 193.05 | ||
| United American | 379.00 | 69.00 | 313.00 | 69.00 | 258.00 |
| UHC to 5/31/2024 | 257.28 | 201.11 | 170.36 | ||
| UHC eff 6/1/2024 | 287.00 | 224.48 | 190.04 | ||
| Choosing a Medigap Policy | |||||
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Prepared for DONALD MATHEWS
Zip code: 91355 Age: 71 |
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UHC rates based on Part B effective less than 10 years
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