| Part A Hospital Services | F-ded | 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) |
$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 |
|
| 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 |
|
| Part B Services | F-ded | 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-ded | G |
| Out of Pocket Limit | 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 |
|
| Foreign Travel Emergency | |
|
| Monthly Rates & Brochures | F-ded | G |
| Anthem | 244.24 | |
| Blue Shield eff 7/1/2024 | S: 264.00 Extra Rider
E: 280.00 |
|
| Continental (Aetna) | 80.72 | 315.79 |
| Health Net | 119.00 | S: 247.00 Additional benefits included with Health Net Innovative plan rider
|
| Humana Achieve eff 8/1/2024 | 239.19 | |
| United American eff 5/1/2024 | 73.00 | 323.00 |
| UHC eff 6/1/2024 | 232.69 |
|
Prepared for
Zip code: 92691 Age: 72 |
|
UHC rates based on Part B effective less than 10 years
|