Part A Hospital Services | A | B | C | D | K | L | M | N |
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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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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
Plan covers 50% Part A deductible50% | |||||
Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | ||||||||
Skilled nursing facility coinsurance | Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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3 Pints of (unreplaced) blood | Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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Part B Services | A | B | C | D | K | L | M | N |
Part B Annual Deductible ($240) | ||||||||
Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
You pay $20 for Dr. office visits You pay $50 for emergency room visits$20/$50 |
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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 | A | B | C | D | K | L | M | N |
Out of Pocket Limit | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
Hospice coverage | Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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Foreign Travel Emergency | ||||||||
Monthly Rates & Brochures | A | B | C | D | K | L | M | N |
Prepared for Zip code: 94941 Age: 96 |
Select all that apply |
If you are new to Medicare the following monthly discounts
are available for your first year of coverage |
Contact us |
(415) 492-0130 |
[email protected] Tiff: [email protected] |
CA Ins Lic 6007844 |