| Part A Hospital Services | A | B | C | D | F | F-ded | G | G-ded | 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) |
 |
|
|
|
$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 |
|
$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 |
|
|
|
|
|
|
|
|
$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 |
|
$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 |
|
| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
|
|
|
|
|
|
|
|
| Skilled nursing facility coinsurance | |
|
|
$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 |
|
$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 |
|
||
| 3 Pints of (unreplaced) blood | |
|
|
|
|
$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 |
|
$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 |
|
| Part B Services | A | B | C | D | F | F-ded | G | G-ded | N |
| Part B Annual Deductible ($240) | |
|
|||||||
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
|
|
|
|
|
|
|
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 |
|
|
|
|
|||||
| Additional Features | A | B | C | D | F | F-ded | G | G-ded | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| Hospice coverage | |
|
|
|
|
$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 |
|
$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 |
|
| Foreign Travel Emergency | |
|
|
|
|
|
|
||
| Monthly Rates & Brochures | A | B | C | D | F | F-ded | G | G-ded | N |
| Anthem | 283.24 | S: 526.34 I: Additional benefits included with Anthem Innovative plan rider
See page 21 or 22 in Anthem brochure for details |
383.04 | 396.26 | |||||
| Blue Shield | 298.00 | 515.00 | S: 417.00 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: 451.00 |
412 | |||||
| Health Net | 352.00 | 425.00 | S: 503.00 Additional benefits included with Health Net Innovative plan rider
|
217.00 | S: 449.00 Additional benefits included with Health Net Innovative plan rider
|
203.00 | 369.00 | ||
| Humana Achieve | 359.75 | 439.93 | 382.27 | 123.41 | 280.93 | ||||
| United American | 276.00 | 377.00 | 510.00 | 456.00 | 529.00 | 99.00 | 435.00 | 99.00 | 359.00 |
| UHC | 310.78 | 433.61 | 523.13 | 525.45 | 410.75 | 347.98 | |||
| Choosing a Medigap Policy | |||||||||
|
Prepared for
Zip code: 93285 Age: 72 Spouse: 67 |
|
UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years
|