| Part A Hospital Services | G | G-ded | K | 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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
|
| 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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
|
| 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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
|
| Part B Services | G | G-ded | K | N |
| Part B Annual Deductible ($240) | ||||
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
|
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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 | G | G-ded | K | N |
| Out of Pocket Limit | NA | NA | $5120 | 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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
|
| Foreign Travel Emergency | |
|
|
|
| Monthly Rates & Brochures | G | G-ded | K | N |
| Anthem | 638.58 | 571.13 | ||
| Blue Shield eff 7/1/2024 | S: 942.00 Extra Rider
E: 974.00 |
767 | ||
| Continental (Aetna) | 409.34 | 309.38 | ||
| Health Net | S: 357.00 Additional benefits included with Health Net Innovative plan rider
|
154.00 | 334.00 | |
| Humana Achieve to 7/31/2024 | 435.09 | 143.34 | 370.95 | |
| Humana Achieve eff 8/1/2024 | 467.57 | 143.34 | 370.95 | |
| United American | 0.00 | 0.00 | 443.00 | |
| UHC eff 6/1/2024 | 317.17 | |||
| Choosing a Medigap Policy | ||||
| Continental: Add $20 application fee. | ||||
|
Prepared for
Zip code: 91321 Age: 60 |
|
Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
UHC rates based on Part B effective less than 10 years UHC Plan G rates reflect $25 Welcome to Medicare discount
|