| 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 | |
|
| Skilled nursing facility coinsurance | |
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| 3 Pints of (unreplaced) blood | |
|
| 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 | |
|
| 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 |
| Out of Pocket Limit | NA | NA |
| Hospice coverage | |
|
| Foreign Travel Emergency | |
|
| Monthly Rates & Brochures | F | G |
| Anthem | 242.62 | 185.46 |
| Blue Shield eff 7/1/2024 | 235.00 | 192.00 |
| Continental (Aetna) | 293.63 | 215.16 |
| Health Net | 220.00 | 186.00 |
| United American | 284.00 | 229.00 |
| UHC eff 6/1/2024 | 224.00 | 175.20 |
|
Prepared for
Zip code: 92821 Age: 65 |
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UHC rates based on Part B effective less than 10 years
|