| 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: 312.20 I: Additional benefits included with Anthem Innovative plan rider
|
227.22 | 235.06 | ||
| Blue Shield eff 7/1/2024 | 289.00 | S: 242.00 Extra Rider
E: 258.00 |
239 | ||
| Blue Shield to 6/30/2024 | 262.00 | S: 219.00 Extra Rider
E: 234.00 |
216 | ||
| Health Net | S: 273.00 Additional benefits included with Health Net Innovative plan rider
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118.00 | S: 244.00 Additional benefits included with Health Net Innovative plan rider
|
106.00 | 210.00 |
| Humana Achieve to 7/31/2024 | 271.37 | 237.46 | 83.75 | 190.89 | |
| Humana Achieve eff 8/1/2024 | 291.56 | 255.13 | 83.75 | 190.89 | |
| Physicians Mutual | 235.66 | 205.90 | 171.38 | ||
| United American | 361.00 | 71.00 | 300.00 | 71.00 | 248.00 |
| UHC to 5/31/2024 | 249.80 | 195.20 | 165.39 | ||
| UHC eff 6/1/2024 | 278.92 | 218.17 | 184.73 | ||
| Choosing a Medigap Policy | |||||
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Prepared for JUDITH HAMILTON
Zip code: 96003 Age: 74 |
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UHC rates based on Part B effective less than 10 years
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