| 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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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 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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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 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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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 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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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 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 | -2.00 | S: -42.00 I: Additional benefits included with Anthem Innovative plan rider
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-2.00 | |||||||||
| Blue Shield | -53.00 | -53.00 | S: -53.00 Extra Rider
E: -53.00 |
-3 | ||||||||
| Continental (Aetna) | 344.28 | 435.58 | 610.42 | 114.12 | 447.40 | 305.54 | ||||||
| Health Net | -60.00 | -60.00 | S: -60.00 Additional benefits included with Health Net Innovative plan rider
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-60.00 | S: -60.00 Additional benefits included with Health Net Innovative plan rider
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-60.00 | -60.00 | |||||
| Humana Achieve | -2.00 | -2.00 | -2.00 | -2.00 | -2.00 | |||||||
| ManhattanLife | 300.50 | 372.16 | 302.16 | 256.66 | ||||||||
| National Health Ins | 349.55 | 457.13 | 134.03 | 389.88 | 308.08 | |||||||
| Physicians Mutual | 330.60 | 413.08 | 359.72 | 297.94 | ||||||||
| United American to 4/30/2024 | 232.00 | 314.00 | 413.00 | 365.00 | 422.00 | 74.00 | 340.00 | 74.00 | 199.00 | 280.00 | 272.00 | |
| United American eff 5/1/2024 | 238.00 | 322.00 | 433.00 | 382.00 | 450.00 | 81.00 | 365.00 | 81.00 | 199.00 | 280.00 | 300.00 | |
| UHC to 5/31/2024 | 238.87 | 334.01 | 403.35 | 405.36 | 266.25 | 221.78 | 267.68 | |||||
| UHC eff 6/1/2024 | 266.67 | 372.87 | 450.25 | 452.26 | 303.10 | 247.24 | 298.83 |
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Prepared for vicki
Zip code: 92126 Age: 65 Spouse: 67 |
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Anthem rates reflect $2 automatic checking discount
Blue Shield rates reflect $3 automatic checking discount
Blue Shield Plan A rates reflect $50 2 party Welcome to Medicare discount
Blue Shield Plan F rates reflect $50 2 party Welcome to Medicare discount
Blue Shield Plan G rates reflect $50 2 party Welcome to Medicare discount
Health Net rates reflect $60 Welcome to Medicare 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 spousal rates based on Part B effective less than 10 years UHC Plan G rates reflect $50 2 party Welcome to Medicare discount
UHC rates reflect $2 automatic checking discount
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