| Part A Hospital Services | G-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) |
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
|
$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 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 | $2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
| 3 Pints of (unreplaced) blood | $2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
| Part B Services | G-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 |
|
| Additional Features | G-ded |
| Out of Pocket Limit | NA |
| Hospice coverage | $2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
| Foreign Travel Emergency | |
| Monthly Rates & Brochures | G-ded |
| Anthem | |
| UHC to 5/31/2024 | |
| UHC eff 6/1/2024 |
|
Prepared for brian
Zip code: 92630 Age: 63 |
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UHC rates based on Part B effective less than 10 years
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