Part A Hospital Services F 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)
  • 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
Part B Annual Deductible ($240)
Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance
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
Out of Pocket Limit NA NA
Hospice coverage
Foreign Travel Emergency
Monthly Rates & Brochures F G
Anthem
S: 365.77
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
356.10
 261.99
Blue Shield eff 7/1/2024 333.00
S: 280.00
Note: Silver Sneakers gym membership is included with all Blue Shield plans.
Additonal benefits with Blue Shield Extra Rider
Foreign Travel - Not covered by Medicare
  • $250 annual deductible, 80% coverage, $50,000 lifetime max (Click the Brochure link, see page 20)
Physician Consultation by Phone or Video Through Teledoc
  • No charge (see brochure page 20)
Over-the-Counter Items through CVS
  • Up to $100 allowance per quarter (see brochure page 20)
Accupuncture and Chiropractic Services (provided by AHS provider network)
  • Up to 20 visits per year, plan pays 100%, see page 21 in brochure for details
Vision Coverage (provided by Vision Service Plan)
  • Exam every 12 months, eyeglasses every 24 months, click the brochure link for details (see page 21)
Hearing Aid Services (provided by Epic Hearing Healthcare)
  • Routine hearing exams, copayments for hearing aids, see page 23 of brochure for details
E: 295.00
Cigna 339.69 276.68
Continental (Aetna) 414.83 303.88
Health Net
S: 299.00
Additional benefits included with Health Net Innovative plan rider
  • Vision Benefits
  • Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
  • Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
  • Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
  • Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
  • Medically necessary contact Lenses - Up to $250 allowance
  • Hearing Benefits
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
    • Level 4 - You pay $1580
    • Level 3 - You pay $1125
    • Level 2 - You pay $700
    • Level 1 - You pay $0
See page 44 in Health Net brochure for detailsI: 305.00
S: 267.00
Additional benefits included with Health Net Innovative plan rider
  • Vision Benefits
  • Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
  • Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
  • Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
  • Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
  • Medically necessary contact Lenses - Up to $250 allowance
  • Hearing Benefits
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
    • Level 4 - You pay $1580
    • Level 3 - You pay $1125
    • Level 2 - You pay $700
    • Level 1 - You pay $0
See page 44 in Health Net brochure for detailsI: 232.00
Humana Achieve 289.56 253.13
National Health Ins 345.23 294.32
Physicians Mutual 311.29 271.12
United American eff 5/1/2024 412.00 343.00
UHC 435.50 340.18
United World Life 338.83 272.03
Blue Shield Frozen Plan F $406
Choosing a Medigap Policy
Continental: Add $20 application fee.
Prepared for
Zip code: 91350
Age: 74

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 10 or more years
UHC rates reflect $2 automatic checking discount