ZapIndex

Part A Hospital Services	A	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	A	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	A	F	G	N
Out of Pocket Limit	NA	NA	NA	NA
Hospice coverage
Foreign Travel Emergency
Monthly Rates & Brochures	A	F	G	N
Anthem CKHH	116.04	S: 217.32 I: Additional benefits included with Anthem Innovative plan rider Vision Benefits Routine eye exam In network: No Charge Out of network: $35 Allowance Eyeglass Frames In network: $100 allowance Out of network: $45 Allowance Eyeglass Lenses Single vision - In network:100% coverage after $25 copay Out of network:$25 benefit after $25 copay Bifocal - In network:100% coverage after $25 copay Out of network:$40 benefit after $25 copay Trifocal or Lenticular - In network:100% coverage after $25 copay Out of network:$55 benefit after $25 copay Contact Lenses In network: $100 allowance Out of network: $80 Allowance Hearing Benefits Coverage through Hearing Care Solutions Hearing exam: 100% coverage Hearing aids: Coverage allowance up to $750 per year Other Innovative Plan Benefits Nurse help line: Speak with a Registered nurse about health related questions Other Benefits (included with both Standard and Innovative Plans) SilverSneakers gym membership See page 21 or 22 in Anthem brochure for details 201.02	157.63	163.15
Physicians Mutual CKHH	148.84	185.98	161.95	134.14
Choosing a Medigap Policy

Prepared for
Zip code: 95677
Age: 65

Anthem rates reflect $2 automatic checking discount

Physicians Mutual rates reflect $5 automatic checking discount