| 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) |
 |
|
|
|
|
| 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 Application | S: 481.73 I: Additional benefits included with Anthem Innovative plan rider
|
345.78 |
| Blue Shield eff 7/1/2024 Application | 577.00 | S: 485.00 Extra Rider
E: 501.00 |
| Continental (Aetna) | 689.97 | 505.80 |
| Health Net Application | S: 434.00 Additional benefits included with Health Net Innovative plan rider
|
S: 387.00 Additional benefits included with Health Net Innovative plan rider
|
| Humana Achieve eff 8/1/2024 | 581.22 | 521.18 |
| ManhattanLife | 824.33 | 722.83 |
| National Health Ins Application | 669.33 | 570.71 |
| Physicians Mutual | 400.32 | 349.28 |
| United American Application | 470.00 | 393.00 |
| UHC eff 6/1/2024 Application | 350.00 | 273.75 |
| Choosing a Medigap Policy | ||
| Continental: Add $20 application fee. | ||
| ManhattanLife: Add $25 application fee. | ||
|
Prepared for
Zip code: 90505 Age: 98 |
|
UHC rates based on Part B effective less than 10 years
|