Part A Hospital Services F G 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 facilityPart 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
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 F G N
Part B Annual Deductible ($240)

Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance 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 F G N
Out of Pocket Limit NA NA NA
Hospice coverage
Foreign Travel Emergency
Monthly Rates & Brochures F G N
Anthem
S: 440.06
I: Additional benefits included with Anthem Innovative plan rider
  • Vision: Routine eye exam $25 copay, $100 frame allowance
  • Hearing: Hearing exam every 12 months, $750 annual allowance for hearing aids
  • Nurse help line: Speak with a Registered nurse about health related questions
  • SilverSneakers gym membership
423.18
 311.76 328.84
Blue Shield eff 7/1/2024 474.00
S: 384.00
Extra Rider
  • Basic gym access through sliver sneakers fitness program (silversneakers.com)
  • Personal emergency response system
  • Physician consultation by phone or video through Teladoc
  • Over the counter items through CVS (Up to $100 one time use per quarter allowance)
  • The vision benefit includes coverage for exams, frames and lenses ($100 frame allowance)
  • Hearing aid benefit includes an annual hearing aid test and coverage for Vista brand mid-level and premium-level hearing aids for a low copay
  • Acupuncture and chiropractic, up to 20 combined visits per calendar year
  • Identity theft protection
E: 400.00
 329
Blue Shield to 6/30/2024 437.00
S: 354.00
Extra Rider
  • Basic gym access through sliver sneakers fitness program (silversneakers.com)
  • Personal emergency response system
  • Physician consultation by phone or video through Teladoc
  • Over the counter items through CVS (Up to $100 one time use per quarter allowance)
  • The vision benefit includes coverage for exams, frames and lenses ($100 frame allowance)
  • Hearing aid benefit includes an annual hearing aid test and coverage for Vista brand mid-level and premium-level hearing aids for a low copay
  • Acupuncture and chiropractic, up to 20 combined visits per calendar year
  • Identity theft protection
E: 369.00
 303
Continental (Aetna) 411.25 301.38 226.24
Health Net
S: 345.00
Additional benefits included with Health Net Innovative plan rider
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid
  • Routine Eye Exam - One vision exam every 12 months
  • Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months
I: 350.00
S: 308.00
Additional benefits included with Health Net Innovative plan rider
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid
  • Routine Eye Exam - One vision exam every 12 months
  • Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months
I: 321.00
 278.00
Humana Achieve 295.61 262.40 218.05
ManhattanLife 332.42 269.42 231.08
National Health Ins 361.23 307.75 243.20
Physicians Mutual 315.71 275.59 229.12
United American to 4/30/2024 331.00 274.00 225.00
United American eff 5/1/2024 352.00 295.00 247.00
UHC to 5/31/2024 304.00 237.50 201.25
UHC eff 6/1/2024 339.00 265.00 224.50
Prepared for
Zip code: 92069
Age: 81

UHC rates based on Part B effective less than 10 years
Lowest cost plans
# Office Visits per Month
Plan Plan F Plan G Plan N
Carrier Humana UHC UHC
Monthly Premium 295.61 237.50 201.25
  • The monthly cost for Plan F is the same as the premium because coverage 100% for eligible expenses
  • Max monthly cost for Plan G is the premium + Medicare Part B deductible divided by 12
  • Max monthly cost for Plan N is the premium + Medicare Part B deductible divided by 12. Office Visits ($20) and Emergency Room Visits ($50) will incur additonal costs in those amounts.
  • Plan N subscribers could incur Plan B excess charges (up to 15% for any physicain provided service) which are not accounted for in this calculation
 Monthly Cost Max 		295.61 257.50 221.25 + OV
Annual Premium 3,547.32 2,850.00 2,415.00
  • The annual cost for Plan F is the same as the premium because coverage 100% for eligible expenses
  • Max annual cost for Plan G is the premium + Medicare Part B deductible
  • Max annual cost for Plan N is the premium + Medicare Part B deductible. Office Visits ($20) and Emergency Room Visits ($50) will incur additonal costs in those amounts.
  • Plan N subscribers could incur Plan B excess charges (up to 15% for any physicain provided service) which are not accounted for in this calculation
 Annual Cost Max 		3,547.32 3,090.00 2,655.00 + OV
Contact us
(714) 889-8773
[email protected]
CA Ins Lic 1234567