| 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) |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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| 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 | |
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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 |
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| 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% |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | G | G-ded | K | N |
| Anthem | 118.67 | 148.64 | ||
| Blue Shield | S: 122.00 Extra Rider
E: 138.00 |
144 | ||
| Cigna | 155.84 | 110.92 | ||
| Continental (Aetna) | 206.33 | 148.02 | ||
| Health Net | S: 140.00 Additional benefits included with Health Net Innovative plan rider
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38.00 | 105.00 | |
| Humana Achieve eff 8/1/2024 | 164.09 | 51.79 | 119.62 | |
| United American | 201.00 | 43.00 | 108.00 | 165.00 |
| UHC | 128.44 | 129.92 | ||
| Choosing a Medigap Policy | ||||
| Continental: Add $20 application fee. | ||||
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Prepared for
Zip code: 94301 Age: 65 |
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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
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
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