| 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: 258.78 I: Additional benefits included with Anthem Innovative plan rider
|
183.32 | 193.37 | ||
| Blue Shield eff 7/1/2024 | 290.00 | S: 238.00 Extra Rider
E: 256.00 |
227 | ||
| Blue Shield to 6/30/2024 | 271.00 | S: 223.00 Extra Rider
E: 239.00 |
212 | ||
| Health Net | S: 253.00 Additional benefits included with Health Net Innovative plan rider
|
109.00 | S: 225.00 Additional benefits included with Health Net Innovative plan rider
|
93.00 | 184.00 |
| Humana Achieve to 7/31/2024 | 177.76 | 153.65 | 54.64 | 120.69 | |
| Humana Achieve eff 8/1/2024 | 190.96 | 165.04 | 54.64 | 120.69 | |
| Physicians Mutual | 208.48 | 182.19 | 151.77 | ||
| United American | 273.00 | 50.00 | 225.00 | 50.00 | 186.00 |
| UHC to 5/31/2024 | 239.94 | 187.56 | 158.94 | ||
| UHC eff 6/1/2024 | 273.60 | 214.02 | 181.26 | ||
| Choosing a Medigap Policy | |||||
|
Prepared for
Zip code: 93023 Age: 70 |
|
Anthem rates reflect 10%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement member may qualify for a household discount for subscriber
Humana Achieve rates 12% household discount UHC rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
|