| Part A Hospital Services | A | B | D | G | G-ded | K | L | M | N |
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| 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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$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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
Plan covers 50% Part A deductible50% | |
| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
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| Skilled nursing facility coinsurance | |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| 3 Pints of (unreplaced) blood | |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| Part B Services | A | B | D | G | G-ded | K | L | M | 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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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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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 | A | B | D | G | G-ded | K | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
| Hospice coverage | |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | B | D | G | G-ded | K | L | M | N |
| Anthem | 141.09 | 142.21 | 176.38 | ||||||
| Blue Shield | 105.00 | S: 154.00 Note: Silver Sneakers gym membership is included with all Blue Shield plans. Additonal benefits with Blue Shield Extra RiderForeign Travel - Not covered by Medicare
Physician Consultation by Phone or Video Through Teledoc
Over-the-Counter Items through CVS
Accupuncture and Chiropractic Services (provided by AHS provider network)
Vision Coverage (provided by Vision Service Plan)
Hearing Aid Services (provided by Epic Hearing Healthcare)
E: 172.00 |
177 | ||||||
| Cigna | 180.42 | 194.39 | 138.36 | ||||||
| Continental (Aetna) | 135.70 | 171.68 | 176.35 | 126.53 | |||||
| Health Net | 116.00 | 144.00 | S: 156.00 Additional benefits included with Health Net Innovative plan rider
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46.00 | 119.00 | ||||
| Humana Achieve | 170.81 | 181.34 | 57.09 | 132.14 | |||||
| National Health Ins | 209.73 | 233.93 | 184.85 | ||||||
| Physicians Mutual | 169.50 | 184.00 | 153.25 | ||||||
| United American | 113.00 | 152.00 | 180.00 | 172.00 | 37.00 | 93.00 | 131.00 | 141.00 | |
| UHC | 143.84 | 200.64 | 165.24 | 133.44 | 161.12 | ||||
| United World Life | 146.51 | 171.55 | 57.58 | 127.57 | |||||
| Choosing a Medigap Policy | |||||||||
| Continental: Add $20 application fee. | |||||||||
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Prepared for Eric Chirstianson
Zip code: 93010 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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