Part A Hospital Services A B C D K L M N
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 facility
Part A Deductible ($1632)

  • The inpatient deductible is $1632 for each benefit period
  • Days 1-60: Medicare covers 100%
  • Days 61-90: You are responsible for $408 per day
  • Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day
  • Beyond lifetime reserve: You are responsible for all costs incurred
Hospital Coinsurance
Plan covers 50% of your out of pocket expenses
Your share is capped at $5120 per year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%
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 year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%

3 Pints of (unreplaced) blood Plan covers 50% of your out of pocket expenses
Your share is capped at $5120 per year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%
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 year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%
You pay $20 for Dr. office visits
You pay $50 for emergency room visits
$20/$50
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 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 year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%
Foreign Travel Emergency


Monthly Rates & Brochures A B C D K L M N
UHC eff 6/1/2024 181.25 252.75 305.00

168.25
203.00

Prepared for
Zip code: 94941
Age: 86
Select all that apply
    Automatic Checking Withdrawal Discount
    If you are new to Medicare the following monthly discounts
    are available for your first year of coverage
    • United Healthcare Plan G: $25 per month
    Welcome
    to Medicare discount 2 party
    UHC/AARPYou can take 7% off your monthly premiums if
    • two or more members are enrolled under the same AARP membership number
    • and each is insured under an eligible AARP-branded supplemental insurance
      policy insured by UnitedHealthcare Insurance Company.
    household discount (7%)
    Contact us
    (415) 492-0130
    [email protected]
    Tiff: [email protected]
    CA Ins Lic 6007844