| 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 | 179.84 | S: 312.76 I: Additional benefits included with Anthem Innovative plan rider
See page 21 or 22 in Anthem brochure for details |
223.92 | 241.07 | ||||||||
| Blue Shield | 153.00 | 280.00 | S: 230.00 Extra Rider
E: 246.00 |
208 | ||||||||
| Cigna | 219.50 | 290.37 | 68.09 | 236.51 | 168.34 | |||||||
| Continental (Aetna) | 200.50 | 253.57 | 355.19 | 66.56 | 260.40 | 188.51 | ||||||
| Health Net | 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 | 210.18 | 256.35 | 221.23 | 71.65 | 161.14 | |||||||
| ManhattanLife | 222.00 | 273.92 | 223.17 | 172.42 | ||||||||
| National Health Ins | 226.71 | 296.66 | 86.85 | 252.99 | 199.80 | |||||||
| Physicians Mutual | 201.62 | 251.93 | 219.37 | 181.71 | ||||||||
| United American | 190.00 | 260.00 | 351.00 | 315.00 | 364.00 | 67.00 | 300.00 | 67.00 | 163.00 | 231.00 | 247.00 | |
| UHC | 161.53 | 226.11 | 273.12 | 274.50 | 214.26 | 149.68 | 181.08 | |||||
| United World Life | 197.79 | 290.87 | 232.84 | 70.30 | 173.14 | |||||||
| Choosing a Medigap Policy | ||||||||||||
| Continental: Add $20 application fee. | ||||||||||||
| ManhattanLife: Add $25 application fee. | ||||||||||||
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Prepared for
Zip code: 92804 Age: 70 |
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Anthem rates reflect $2 automatic checking discount
Blue Shield rates reflect $3 automatic checking discount
Humana Achieve rates reflect $2 automatic checking discount
Physicians Mutual rates reflect $5 automatic checking discount
UHC rates based on Part B effective less than 10 years UHC rates reflect $2 automatic checking discount
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