

| Part A Hospital Services | F-ded |
|---|---|
| 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 |
| 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 | F-ded |
| Out of Pocket Limit | 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 |
| Anthem | |
| Blue Shield | |
| Cigna | 90.52 |
| Continental (Aetna) | 98.46 |
| Health Net | 148.00 |
| Humana Achieve | |
| National Health Ins | 115.76 |
| Physicians Mutual | |
| United American | 90.00 |
| UHC | |
| United World Life | |
| Choosing a Medigap Policy | |
| Continental: Add $20 application fee. | |
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Prepared for Janet Ridley
Zip code: 92646 Age: 78 |
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UHC rates based on Part B effective less than 10 years
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