Part A Hospital Services F
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 facility
Part A Deductible ($1632)
  • 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
Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage
Skilled nursing facility coinsurance
3 Pints of (unreplaced) blood
Part B Services F
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
Out of Pocket Limit NA
Hospice coverage
Foreign Travel Emergency
Monthly Rates & Brochures F
Blue Shield eff 7/1/2024 646.00
Health Net
S: 598.00
Additional benefits included with Health Net Innovative plan rider
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid
  • Routine Eye Exam - One vision exam every 12 months
  • Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months
I: 610.00
ManhattanLife 617.66

Prepared for
Zip code: 91024
Age: 73
Spouse: 73
Select all that apply
    Automatic Checking Withdrawal Discount
    If you are new to Medicare the following monthly discounts
    are available for your first year of coverage
    • Blue Shield Plans A. F and G: $25 per month
    • Health Net All Plans: $30 per month
    Welcome
    to Medicare discount 2 party
    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%)
    ManhattanLifeManhattanLife offers a 7% household premium discount
    • if you are marriied and residing with your spouse
    • or have been residing, for at the past 12 months, with someone who is 60 or over
    household discount (7%)
    Contact us
    (626) 695-0863
    [email protected]
    CA Ins Lic 547175