| Part A Hospital Services | A | B | C | D | F | F-ded | G | G-ded | 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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 | |
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| Skilled nursing facility coinsurance | |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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 | |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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 | F | F-ded | G | G-ded | K | L | M | N |
| Part B Annual Deductible ($240) | |
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| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
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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% |
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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 |
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| Additional Features | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
| Hospice coverage | |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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 | |
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| Monthly Rates & Brochures | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Anthem Application | 170.75 | S: 297.02 I: Additional benefits included with Anthem Innovative plan rider
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212.62 | 228.92 | ||||||||
| Blue Shield eff 7/1/2024 Application | 142.08 | 260.19 | S: 213.69 Extra Rider
E: 228.57 |
193.23 | ||||||||
| Blue Shield to 6/30/2024 Application | 142.08 | 243.45 | S: 199.74 Extra Rider
E: 213.69 |
180.21 | ||||||||
| Continental (Aetna) | 200.50 | 253.57 | 355.19 | 66.56 | 260.40 | 188.51 | ||||||
| Health Net Application | 180.00 | 225.00 | S: 257.00 Additional benefits included with Health Net Innovative plan rider
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112.00 | S: 229.00 Additional benefits included with Health Net Innovative plan rider
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98.00 | 194.00 | |||||
| Humana Achieve to 7/31/2024 | 171.81 | 209.60 | 180.86 | 62.81 | 141.56 | |||||||
| Humana Achieve eff 8/1/2024 | 184.72 | 225.35 | 194.44 | 62.81 | 141.56 | |||||||
| ManhattanLife | 188.56 | 232.73 | 189.56 | 160.35 | ||||||||
| National Health Ins Application | 226.71 | 296.66 | 86.85 | 252.99 | 199.80 | |||||||
| Physicians Mutual | 201.62 | 251.93 | 219.37 | 181.71 | ||||||||
| United American to 4/30/2024 Application | 185.00 | 253.00 | 335.00 | 300.00 | 342.00 | 61.00 | 279.00 | 61.00 | 163.00 | 231.00 | 225.00 | |
| United American eff 5/1/2024 Application | 190.00 | 260.00 | 351.00 | 315.00 | 364.00 | 67.00 | 300.00 | 67.00 | 163.00 | 231.00 | 247.00 | |
| UHC to 5/31/2024 Application | 131.56 | 184.48 | 222.82 | 223.90 | 174.58 | 122.02 | 147.58 | |||||
| UHC eff 6/1/2024 Application | 147.04 | 205.90 | 248.74 | 250.00 | 195.10 | 136.24 | 164.86 |
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Prepared for
Zip code: 92804 Age: 70 |
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Anthem rates reflect 5%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement for subscribermember may qualify for a household discount
Anthem rates reflect $2 automatic checking discount
Blue Shield rates reflect 7% You are eligible for a 7% household premium discount if you reside with another person
who is on the same Blue Shield Medicare Supplement plan, including same Dental plan. Only one policy will be issued, the second party will be covered as a dependent.household discount Blue Shield rates reflect $3 automatic checking discount
Humana Achieve rates 12% household discount Humana Achieve rates reflect $2 automatic checking discount
Manhatten Life rates reflect 7% You are eligible for a 7% household premium discount if
(a) you are married and residing with your spouse or (b) for the past year you have resided with soneone who is at least 60 years old.household discount Physicians Mutual rates reflect $5 automatic checking discount
UHC rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
UHC rates reflect $2 automatic checking discount
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