| Part A Hospital Services | F | F-ded | 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) |
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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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| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
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| Skilled nursing facility coinsurance | |
$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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| 3 Pints of (unreplaced) blood | |
$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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| Part B Services | F | F-ded | G |
| 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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| 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 | F | F-ded | G |
| Out of Pocket Limit | NA | NA | NA |
| Hospice coverage | |
$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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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | F-ded | G |
| Anthem | S: 440.06 I: Additional benefits included with Anthem Innovative plan rider
|
311.76 | |
| Blue Shield eff 7/1/2024 | 485.00 | S: 400.00 Extra Rider
E: 417.00 |
|
| Blue Shield to 6/30/2024 | 447.00 | S: 369.00 Extra Rider
E: 385.00 |
|
| Continental (Aetna) | 395.43 | 74.05 | 289.63 |
| Health Net | S: 380.00 Additional benefits included with Health Net Innovative plan rider
|
164.00 | S: 337.00 Additional benefits included with Health Net Innovative plan rider
|
| Humana Achieve to 7/31/2024 | 307.34 | 273.14 | |
| Humana Achieve eff 8/1/2024 | 330.24 | 293.48 | |
| ManhattanLife | 379.75 | 310.33 | |
| National Health Ins | 372.08 | 108.94 | 316.96 |
| Physicians Mutual | 325.02 | 283.71 | |
| United American | 352.00 | 76.00 | 295.00 |
| UHC to 5/31/2024 | 380.00 | 296.87 | |
| UHC eff 6/1/2024 | 423.75 | 331.25 |
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Prepared for
Zip code: 92352 Age: 82 |
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UHC rates based on Part B effective 10 or more years
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