| Part A Hospital Services | F | G |
|---|---|---|
| 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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| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
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| Skilled nursing facility coinsurance | |
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| 3 Pints of (unreplaced) blood | |
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| Part B Services | F | G |
| Part B Annual Deductible ($240) | |
|
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
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| 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 | F | G |
| Out of Pocket Limit | NA | NA |
| Hospice coverage | |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | G |
| Anthem | 712.20 | 527.98 |
| Blue Shield eff 7/1/2024 | 690.00 | 610.00 |
| Continental (Aetna) | 931.62 | 682.40 |
| Health Net | 610.00 | 538.00 |
| Humana Achieve | 542.74 | 474.92 |
| United American eff 5/1/2024 | 824.00 | 686.00 |
| UHC eff 6/1/2024 | 637.00 | 498.23 |
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Prepared for
Zip code: 92692 Age: 74 Spouse: 74 |
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UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years
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