| 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 facilityPart A Deductible ($1632) |
 |
|
|
| 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 | 0.00 |
| Health Net | S: 0.00 Additional benefits included with Health Net Innovative plan rider
|
| Choosing a Medigap Policy | |
|
Prepared for
Zip code: Age: 78 Spouse: 74 |
|
Blue Shield rates reflect 7% You 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
|