

| Part A Hospital Services | F | G | N |
|---|---|---|---|
| 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 | ![]() |
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| Skilled nursing facility coinsurance | ![]() |
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| 3 Pints of (unreplaced) blood | ![]() |
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| Part B Services | F | G | N |
| Part B Annual Deductible ($240) | ![]() |
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| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | ![]() |
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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 | F | G | N |
| Out of Pocket Limit | NA | NA | NA |
| Hospice coverage | ![]() |
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| Foreign Travel Emergency | ![]() |
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| Monthly Rates & Brochures | F | G | N |
| UHC | 421.75 | 329.25 | 278.62 |
| Choosing a Medigap Policy | |||
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Prepared for DORA
Zip code: 92071 Age: 82 |
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UHC rates based on Part B effective 10 or more years UHC rates reflect $2 automatic checking discount
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