| Part A Hospital Services | F | F-ded | 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 |
|
|
|
|
$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 |
|
$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 |
|
$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 | F | F-ded | 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 | F | F-ded | G | G-ded | K | N |
| Out of Pocket Limit | NA | NA | 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 |
|
$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 | F | F-ded | G | G-ded | K | N |
| Anthem | S: 708.06 I: Additional benefits included with Anthem Innovative plan rider
See page 21 or 22 in Anthem brochure for details |
508.23 | 546.81 | |||
| Blue Shield | 641.00 | S: 539.00 Extra Rider
E: 571.00 |
504 | |||
| Health Net | S: 577.00 Additional benefits included with Health Net Innovative plan rider
|
248.00 | S: 462.00 Additional benefits included with Health Net Innovative plan rider
|
237.00 | 445.00 | |
| Humana Achieve to 7/31/2024 | 527.28 | 460.09 | 162.44 | 367.90 | ||
| Humana Achieve eff 8/1/2024 | 566.52 | 494.32 | 162.44 | 367.90 | ||
| Physicians Mutual | 559.80 | 488.17 | 405.17 | |||
| United American | 802.00 | 154.00 | 666.00 | 154.00 | 346.00 | 551.00 |
| UHC | 567.00 | 443.48 | 375.44 | |||
| Choosing a Medigap Policy | ||||||
|
Prepared for MARTHA LAFF & HOWARD
Zip code: 91344 Age: 74 Spouse: 72 |
|
UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
|