| 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 | 440.42 | S: 738.10 I: Additional benefits included with Anthem Innovative plan rider
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522.33 | 551.06 | ||||||||
| Blue Shield eff 7/1/2024 | 432.00 | 728.00 | S: 612.00 Extra Rider
E: 644.00 |
582 | ||||||||
| Blue Shield to 6/30/2024 | 432.00 | 671.00 | S: 564.00 Extra Rider
E: 594.00 |
537 | ||||||||
| Continental (Aetna) | 416.09 | 526.13 | 737.21 | 137.86 | 540.45 | 380.17 | ||||||
| Health Net | 412.00 | 546.00 | S: 588.00 Additional benefits included with Health Net Innovative plan rider
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254.00 | S: 470.00 Additional benefits included with Health Net Innovative plan rider
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248.00 | 472.00 | |||||
| Humana Achieve | 406.24 | 503.02 | 443.45 | 151.55 | 361.31 | |||||||
| ManhattanLife | 442.08 | 551.59 | 444.25 | 375.66 | ||||||||
| National Health Ins | 479.31 | 627.35 | 183.55 | 535.00 | 422.29 | |||||||
| Physicians Mutual | 427.02 | 544.07 | 473.84 | 392.46 | ||||||||
| United American to 4/30/2024 | 316.00 | 442.00 | 600.00 | 544.00 | 612.00 | 121.00 | 506.00 | 121.00 | 275.00 | 388.00 | 411.00 | |
| United American eff 5/1/2024 | 324.00 | 454.00 | 630.00 | 572.00 | 652.00 | 131.00 | 544.00 | 131.00 | 275.00 | 388.00 | 451.00 | |
| UHC to 5/31/2024 | 352.11 | 491.98 | 593.93 | 596.88 | 465.88 | 326.99 | 394.46 | |||||
| UHC eff 6/1/2024 | 392.99 | 549.11 | 662.88 | 665.83 | 520.05 | 364.42 | 440.27 |
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Prepared for Mike & Lori
Zip code: 92009 Age: 77 Spouse: 76 |
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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 spousal rates based on Part B effective less than 10 years UHC rates reflect $2 automatic checking discount
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