

| Part A Hospital Services | G | 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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| 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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| 3 Pints of (unreplaced) blood | ![]() |
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| Part B Services | G | 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 |
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| Additional Features | G | N |
| Out of Pocket Limit | NA | NA |
| Hospice coverage | ![]() |
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| Foreign Travel Emergency | ![]() |
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| Monthly Rates & Brochures | G | N |
| Anthem | 167.21 | 176.38 |
| Blue Shield | S: 171.00 Extra Rider
E: 188.00 |
168 |
| Humana Achieve | 215.83 | 157.16 |
| UHC | 175.20 | 148.32 |
| Choosing a Medigap Policy | ||
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Prepared for
Zip code: 93510 Age: 65 |
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UHC rates based on Part B effective less than 10 years
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