| Part A Hospital Services | 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 |
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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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| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
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| 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 |
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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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| 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 |
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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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| Part B Services | 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 | |
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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 | F-ded | G | G-ded | N |
| Out of Pocket Limit | 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 |
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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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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F-ded | G | G-ded | N |
| Anthem | 142.21 | 176.38 | ||
| Blue Shield eff 7/1/2024 | S: 154.00 Extra Rider
E: 172.00 |
177 | ||
| Continental (Aetna) | 44.98 | 176.35 | 126.53 | |
| Health Net | 60.00 | S: 156.00 Additional benefits included with Health Net Innovative plan rider
|
46.00 | 119.00 |
| Humana Achieve eff 8/1/2024 | 181.34 | 57.09 | 132.14 | |
| United American eff 5/1/2024 | 37.00 | 172.00 | 37.00 | 141.00 |
| UHC to 5/31/2024 | 141.72 | 141.28 | ||
| UHC eff 6/1/2024 | 165.24 | 161.12 |
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Prepared for
Zip code: 93003 Age: 65 |
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Anthem Plan G rates reflect $25.00 Welcome to Medicare discount
Blue Shield Plan G rates reflect $25 Welcome to Medicare discount
Health Net rates reflect $30 Welcome to Medicare discount
UHC rates based on Part B effective less than 10 years UHC Plan G rates reflect $25 Welcome to Medicare discount
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