| 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: 239.22 I: Additional benefits included with Anthem Innovative plan rider
|
169.46 | 178.76 | ||
| Blue Shield eff 7/1/2024 | 269.00 | S: 213.00 Extra Rider
E: 230.00 |
204 | ||
| Blue Shield to 6/30/2024 | 248.00 | S: 196.00 Extra Rider
E: 212.00 |
188 | ||
| Health Net | S: 231.00 Additional benefits included with Health Net Innovative plan rider
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100.00 | S: 206.00 Additional benefits included with Health Net Innovative plan rider
|
85.00 | 167.00 |
| Humana Achieve to 7/31/2024 | 195.76 | 170.31 | 58.61 | 133.55 | |
| Humana Achieve eff 8/1/2024 | 210.29 | 182.94 | 58.61 | 133.55 | |
| Physicians Mutual | 193.59 | 169.22 | 141.02 | ||
| United American | 247.00 | 45.00 | 203.00 | 45.00 | 167.00 |
| UHC to 5/31/2024 | 219.95 | 171.93 | 145.70 | ||
| UHC eff 6/1/2024 | 250.80 | 196.19 | 166.16 | ||
| Choosing a Medigap Policy | |||||
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Prepared for DORENE BLAIR
Zip code: 93012 Age: 68 |
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Anthem rates reflect 10%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement member may qualify for a household discount for subscriber
UHC rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
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