| Part A Hospital Services | 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) |
 |
|
|
| 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 | 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 | G |
| Out of Pocket Limit | NA |
| Hospice coverage | |
| Foreign Travel Emergency | |
| Monthly Rates & Brochures | G |
| Anthem | 200.79 |
| Blue Shield eff 7/1/2024 | 207.00 |
| Continental (Aetna) | 260.73 |
| Health Net | 189.00 |
| Humana Achieve to 7/31/2024 | 200.91 |
| United American | 258.00 |
| UHC eff 6/1/2024 | 191.63 |
| Choosing a Medigap Policy | |
| Continental: Add $20 application fee. | |
|
Prepared for
Zip code: 90278 Age: 67 |
|
UHC rates based on Part B effective less than 10 years
|