| 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: 335.96 I: Additional benefits included with Anthem Innovative plan rider
|
238.01 | 251.05 | ||
| Blue Shield eff 7/1/2024 | 352.00 | S: 296.00 Extra Rider
E: 312.00 |
287 | ||
| Blue Shield to 6/30/2024 | 319.00 | S: 268.00 Extra Rider
E: 283.00 |
260 | ||
| Health Net | S: 294.00 Additional benefits included with Health Net Innovative plan rider
|
127.00 | S: 261.00 Additional benefits included with Health Net Innovative plan rider
|
110.00 | 218.00 |
| Humana Achieve to 7/31/2024 | 227.92 | 199.49 | 70.57 | 160.42 | |
| Humana Achieve eff 8/1/2024 | 244.86 | 214.31 | 70.57 | 160.42 | |
| Physicians Mutual | 235.66 | 205.90 | 171.38 | ||
| United American | 309.00 | 61.00 | 257.00 | 61.00 | 213.00 |
| UHC to 5/31/2024 | 303.26 | 237.06 | 200.88 | ||
| UHC eff 6/1/2024 | 345.80 | 270.50 | 229.09 | ||
| Choosing a Medigap Policy | |||||
|
Prepared for SANDRA KLEIN
Zip code: 93065 Age: 74 |
|
UHC rates based on Part B effective less than 10 years
|