Part A Hospital Services 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
  • The inpatient deductible is $1632 for each benefit period
  • Days 1-60: Medicare covers 100%
  • Days 61-90: You are responsible for $408 per day
  • Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day
  • Beyond lifetime reserve: You are responsible for all costs incurred
Hospital 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
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
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
Part B Services 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 G G-ded N
Out of Pocket Limit 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
Foreign Travel Emergency
Monthly Rates & Brochures G G-ded N
Anthem 148.99
183.52
Blue Shield eff 7/1/2024
S: 165.00
Extra Rider
  • Basic gym access through sliver sneakers fitness program (silversneakers.com)
  • Personal emergency response system
  • Physician consultation by phone or video through Teladoc
  • Over the counter items through CVS (Up to $100 one time use per quarter allowance)
  • The vision benefit includes coverage for exams, frames and lenses ($100 frame allowance)
  • Hearing aid benefit includes an annual hearing aid test and coverage for Vista brand mid-level and premium-level hearing aids for a low copay
  • Acupuncture and chiropractic, up to 20 combined visits per calendar year
  • Identity theft protection
E: 181.00
189
Cigna 202.17
143.89
Continental (Aetna) 223.58
160.69
Health Net
S: 156.00
Additional benefits included with Health Net Innovative plan rider
  • Vision Benefits
  • Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
  • Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
  • Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
  • Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
  • Medically necessary contact Lenses - Up to $250 allowance
  • Hearing Benefits
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
    • Level 4 - You pay $1580
    • Level 3 - You pay $1125
    • Level 2 - You pay $700
    • Level 1 - You pay $0
See page 44 in Health Net brochure for detailsI: 146.00
 46.00 119.00
Humana Achieve 181.34 57.09 132.14
National Health Ins 233.93
184.85
Physicians Mutual 208.32
173.40
United American eff 5/1/2024 244.00 54.00 200.00
UHC 174.16
168.67
United World Life 186.99 62.76 139.05
Choosing a Medigap Policy
Continental: Add $20 application fee.

Prepared for
Zip code: 91362
Age: 66
Select all that apply
  • Anthem $2 per month
  • Blue Shield $3 per month
  • Humana Achieve $2 per month
  • Physicians Mutual $5 per month
  • United Healthcare $2 per month
Automatic Checking Withdrawal Discount
If you are new to Medicare the following monthly discounts
are available for your first year of coverage
  • Anthem Plan F: $20 Plans G: $25 per month
  • Blue Shield Plans A. F and G: $25 per month
  • Health Net All Plans: $30 per month
  • United Healthcare Plan G: $25 per month
Welcome to Medicare discount 2 party
Enrollees who live with another Anthem Medicare Supplement
member may qualify for a household discount.
  • For members with an original Anthem Blue Cross
    effective date after 2/28/2023 the discount is 10%
  • For those with original effective dates between
    6/1/2010 and 2/28/2023 the discount is 5%
  • The household discount is not available to persons
    enrolled before 6/1/2010
Anthem household discount
Blue ShieldYou are eligible for a 7% household premium discount
  • if you reside with another person who is on the same Blue Shield Medicare Supplement plan
  • including same Dental plan.
Only one policy will be issued, the second party will be covered as a dependent. household discount (7%)
Cigna Cigna
  • You are eligible for a 6% household you live with another person age 18 or over
  • You are eligible for a 11% discount if another person in your household has a Cigna Medicare Supplement plan
household discount
Humana AchieveHumana Achieve offers a 12% household premium discount
  • if you reside with your spouse or domestic partner
  • or if you have resided with one to three adults for the past 12 months.
 household discount (12%)
National Health Ins National Health Insurance
  • You are eligible for a 7% household premium discount if you have a roommate
  • You are eligible for a 10% discount if multiple people in your household are
    covered by National Health Ins. medicare supplement policies
household discount
Physicians Mutual 10% Physicians Mutual offers a 10% household premium discount
if you are marriied
or reside with another person age 60 or over.household discount
UHC/AARPYou can take 7% off your monthly premiums if
  • two or more members are enrolled under the same AARP membership number
  • and each is insured under an eligible AARP-branded supplemental insurance
    policy insured by UnitedHealthcare Insurance Company.
 household discount (7%)
Contact us
(818) 888-0880
[email protected]
CA Ins Lic OA2225