ZapIndex

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)
The inpatient deductible is $1632 for each benefit period Days 1-60: Medicare covers 100% Days 61-90: You are responsible for $408 per day Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day Beyond lifetime reserve: You are responsible for all costs incurred Hospital Coinsurance
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 CKHH	S: 314.76 I: Additional benefits included with Anthem Innovative plan rider Vision Benefits Routine eye exam In network: No Charge Out of network: $35 Allowance Eyeglass Frames In network: $100 allowance Out of network: $45 Allowance Eyeglass Lenses Single vision - In network:100% coverage after $25 copay Out of network:$25 benefit after $25 copay Bifocal - In network:100% coverage after $25 copay Out of network:$40 benefit after $25 copay Trifocal or Lenticular - In network:100% coverage after $25 copay Out of network:$55 benefit after $25 copay Contact Lenses In network: $100 allowance Out of network: $80 Allowance Hearing Benefits Coverage through Hearing Care Solutions Hearing exam: 100% coverage Hearing aids: Coverage allowance up to $750 per year Other Innovative Plan Benefits Nurse help line: Speak with a Registered nurse about health related questions Other Benefits (included with both Standard and Innovative Plans) SilverSneakers gym membership See page 21 or 22 in Anthem brochure for details 301.09	225.92
Health Net	S: 257.00 Additional benefits included with Health Net Innovative plan rider Vision Benefits Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance Medically necessary contact Lenses - Up to $250 allowance Hearing Benefits Routine Hearing Exam - One hearing exam every 12 months Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions Level 4 - You pay $1580 Level 3 - You pay $1125 Level 2 - You pay $700 Level 1 - You pay $0 See page 44 in Health Net brochure for detailsI: 264.00	S: 229.00 Additional benefits included with Health Net Innovative plan rider Vision Benefits Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance Medically necessary contact Lenses - Up to $250 allowance Hearing Benefits Routine Hearing Exam - One hearing exam every 12 months Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions Level 4 - You pay $1580 Level 3 - You pay $1125 Level 2 - You pay $700 Level 1 - You pay $0 See page 44 in Health Net brochure for detailsI: 227.00
UHC eff 6/1/2024 CKHH	276.50	216.26
Choosing a Medigap Policy

Part A Hospital Services

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)

The inpatient deductible is $1632 for each benefit period
Days 1-60: Medicare covers 100%
Days 61-90: You are responsible for $408 per day
Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day
Beyond lifetime reserve: You are responsible for all costs incurred

Hospital Coinsurance

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

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

Out of Pocket Limit

Hospice coverage

Foreign Travel Emergency

Monthly Rates & Brochures

Anthem CKHH

S: 314.76
I: Additional benefits included with Anthem Innovative plan rider

Vision Benefits
Routine eye exam In network: No Charge Out of network: $35 Allowance
Eyeglass Frames In network: $100 allowance Out of network: $45 Allowance
Eyeglass Lenses
- Single vision - In network:100% coverage after $25 copay Out of network:$25 benefit after $25 copay
- Bifocal - In network:100% coverage after $25 copay Out of network:$40 benefit after $25 copay
- Trifocal or Lenticular - In network:100% coverage after $25 copay Out of network:$55 benefit after $25 copay
Contact Lenses In network: $100 allowance Out of network: $80 Allowance
Hearing Benefits Coverage through Hearing Care Solutions
Hearing exam: 100% coverage
Hearing aids: Coverage allowance up to $750 per year
Other Innovative Plan Benefits
Nurse help line: Speak with a Registered nurse about health related questions
Other Benefits (included with both Standard and Innovative Plans)
SilverSneakers gym membership

See page 21 or 22 in Anthem brochure for details

301.09

225.92

Health Net

S: 257.00
Additional benefits included with Health Net Innovative plan rider

Vision Benefits
Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
Medically necessary contact Lenses - Up to $250 allowance
Hearing Benefits
Routine Hearing Exam - One hearing exam every 12 months
Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
- Level 4 - You pay $1580
- Level 3 - You pay $1125
- Level 2 - You pay $700
- Level 1 - You pay $0

See page 44 in Health Net brochure for detailsI: 264.00

S: 229.00
Additional benefits included with Health Net Innovative plan rider

Vision Benefits
Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
Medically necessary contact Lenses - Up to $250 allowance
Hearing Benefits
Routine Hearing Exam - One hearing exam every 12 months
Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
- Level 4 - You pay $1580
- Level 3 - You pay $1125
- Level 2 - You pay $700
- Level 1 - You pay $0

See page 44 in Health Net brochure for detailsI: 227.00

UHC eff 6/1/2024 CKHH

276.50

216.26

Choosing a Medigap Policy

Select all that apply

Anthem $2 per month

Automatic Checking Withdrawal Discount

If you are new to Medicare the following monthly discounts
are available for your first year of coverage

Anthem Plan F: $20 Plans G: $25 per month
Health Net All Plans: $30 per month
United Healthcare Plan G: $25 per month

Welcome to Medicare discount 2 party

Anthem Plan F rates reflect $20 Welcome to Medicare discount.

Anthem Plan F rates reflect $40 2 party Welcome to Medicare discount.

Anthem Plan G rates reflect $25 Welcome to Medicare discount.

Anthem Plan G rates reflect $50 2 party Welcome to Medicare discount.

Enrollees who live with another Anthem Medicare Supplement
member may qualify for a household discount.

For members with an original Anthem Blue Cross
effective date after 2/28/2023 the discount is 10%
For those with original effective dates between
6/1/2010 and 2/28/2023 the discount is 5%
The household discount is not available to persons
enrolled before 6/1/2010

Anthem household discount

Anthem rates reflect $2 automatic checking discount.

Blue Shield rates reflect $3 automatic checking discount.

Continental Life You are be eligible for a 5% discount if you reside with another
person covered by Continental Life who is either
(a) your spouse;
(b) someone with whom you are in a civil union partnership;
(c) a permanent resident in your home.5% household discount

Health Net rates reflect $30 Welcome to Medicare discount.

Health Net rates reflect $60 2 party Welcome to Medicare discount.

Humana Achieve rates reflect $2 automatic checking discount.

Physicians Mutual rates reflect $5 automatic checking discount.

UHC Plan G rates reflect $25 Welcome to Medicare discount.

UHC Plan G rates reflect $50 2 party Welcome to Medicare discount.

United Healthcare rates reflect $2 automatic checking discount.

UHC/AARPYou can take 7% off your monthly premiums if

two or more members are enrolled under the same AARP membership number
and each is insured under an eligible AARP-branded supplemental insurance
policy insured by UnitedHealthcare Insurance Company.

household discount (7%)