| Part A Hospital Services | F | G-ded |
|---|---|---|
| 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 |
| 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 | F | G-ded |
| Part B Annual Deductible ($240) | |
|
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
|
| 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 | G-ded |
| Out of Pocket Limit | 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 | F | G-ded |
| Anthem | S: 349.19 I: Additional benefits included with Anthem Innovative plan rider
|
|
| Blue Shield eff 7/1/2024 | 325.00 | |
| Blue Shield to 6/30/2024 | 306.00 | |
| Continental (Aetna) | 335.78 | |
| Health Net | S: 314.00 Additional benefits included with Health Net Innovative plan rider
|
120.00 |
| Humana Achieve eff 8/1/2024 | 255.56 | 73.75 |
| ManhattanLife | 259.17 | |
| Physicians Mutual | 265.21 | |
| United American eff 5/1/2024 | 317.00 | 64.00 |
| UHC eff 6/1/2024 | 318.66 |
|
Prepared for
Zip code: 92399 Age: 75 |
|
UHC rates based on Part B effective less than 10 years
|