| 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: -22.00 I: Additional benefits included with Anthem Innovative plan rider
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-2.00 | |||||||||
| Blue Shield eff 7/1/2024 | -28.00 | -28.00 | S: -28.00 Extra Rider
E: -28.00 |
-3 | ||||||||
| Blue Shield to 6/30/2024 | -28.00 | -28.00 | S: -28.00 Extra Rider
E: -28.00 |
-3 | ||||||||
| Continental (Aetna) | 135.70 | 171.68 | 240.65 | 44.98 | 176.35 | 126.53 | ||||||
| Health Net | -30.00 | -30.00 | S: -30.00 Additional benefits included with Health Net Innovative plan rider
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-30.00 | S: -30.00 Additional benefits included with Health Net Innovative plan rider
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-30.00 | -30.00 | |||||
| Humana Achieve | -2.00 | -2.00 | -2.00 | -2.00 | -2.00 | |||||||
| ManhattanLife | 150.25 | 186.08 | 151.08 | 128.33 | ||||||||
| National Health Ins | 174.78 | 228.56 | 67.01 | 194.94 | 154.04 | |||||||
| Physicians Mutual | 165.30 | 206.54 | 179.86 | 148.97 | ||||||||
| United American to 4/30/2024 | 110.00 | 148.00 | 195.00 | 172.00 | 200.00 | 34.00 | 160.00 | 34.00 | 93.00 | 131.00 | 128.00 | |
| United American eff 5/1/2024 | 113.00 | 152.00 | 205.00 | 180.00 | 213.00 | 37.00 | 172.00 | 37.00 | 93.00 | 131.00 | 141.00 | |
| UHC to 5/31/2024 | 113.04 | 158.48 | 191.60 | 192.56 | 125.00 | 104.88 | 126.80 | |||||
| UHC eff 6/1/2024 | 126.32 | 177.04 | 214.00 | 214.96 | 142.60 | 117.04 | 141.68 |
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Prepared for Janette
Zip code: 92026 Age: 65 |
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Anthem rates reflect $2 automatic checking discount
Anthem Plan F rates reflect $20.00 Welcome to Medicare discount
Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield rates reflect $3 automatic checking discount
Blue Shield Plan F rates reflect $25 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 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 Plan G rates reflect $25 Welcome to Medicare discount
UHC rates reflect $2 automatic checking discount
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