

| Part A Hospital Services | 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) |
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| 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 | 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 |
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| Additional Features | G |
| Out of Pocket Limit | NA |
| Hospice coverage | ![]() |
| Foreign Travel Emergency | ![]() |
| Monthly Rates & Brochures | G |
| Anthem | 225.92 |
| Blue Shield eff 7/1/2024 | S: 227.00 Extra Rider
E: 242.00 |
| Continental (Aetna) | 292.38 |
| Health Net | S: 229.00 Additional benefits included with Health Net Innovative plan rider
|
| Humana Achieve eff 8/1/2024 | 223.23 |
| United American eff 5/1/2024 | 300.00 |
| UHC eff 6/1/2024 | 197.10 |
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Prepared for
Zip code: 90814 Age: 70 |
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UHC rates based on Part B effective less than 10 years UHC rates reflect 7% You can take 7% off your monthly premiums if
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