| Part A Hospital Services | A | B | C | D | F | F-ded | G | G-ded | K | L | M | 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) |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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 | 261.05 | S: 438.06 I: Additional benefits included with Anthem Innovative plan rider
See page 21 or 22 in Anthem brochure for details |
309.76 | 326.84 | ||||||||
| Blue Shield | 264.00 | 534.00 | S: 447.00 Note: Silver Sneakers gym membership is included with all Blue Shield plans. Additonal benefits with Blue Shield Extra RiderForeign Travel - Not covered by Medicare
Physician Consultation by Phone or Video Through Teledoc
Over-the-Counter Items through CVS
Accupuncture and Chiropractic Services (provided by AHS provider network)
Vision Coverage (provided by Vision Service Plan)
Hearing Aid Services (provided by Epic Hearing Healthcare)
E: 465.00 |
370 | ||||||||
| Cigna | 299.58 | 396.30 | 92.93 | 322.79 | 241.15 | |||||||
| Continental (Aetna) | 296.88 | 375.52 | 526.04 | 98.46 | 385.68 | 290.55 | ||||||
| Health Net | 270.00 | 341.00 | S: 386.00 Additional benefits included with Health Net Innovative plan rider
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166.00 | S: 344.00 Additional benefits included with Health Net Innovative plan rider
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149.00 | 294.00 | |||||
| Humana Achieve | 281.28 | 370.42 | 330.11 | 98.25 | 258.42 | |||||||
| UHC | 248.62 | 347.68 | 419.87 | 421.75 | 329.25 | 230.50 | 278.62 | |||||
| United World Life | 308.49 | 453.66 | 364.22 | 103.65 | 269.36 | |||||||
| Choosing a Medigap Policy | ||||||||||||
| Continental: Add $20 application fee. | ||||||||||||
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Prepared for Carole M
Zip code: 92129 Age: 85 |
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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
UHC rates based on Part B effective 10 or more years UHC rates reflect $2 automatic checking discount
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