

| Part A Hospital Services | K | L |
|---|---|---|
| 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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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% |
| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | ![]() |
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| Skilled nursing facility coinsurance | 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% |
| 3 Pints of (unreplaced) blood | 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% |
| Part B Services | K | L |
| Part B Annual Deductible ($240) | ||
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | 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% |
| 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 | K | L |
| Out of Pocket Limit | $5120 | $2560 |
| Hospice coverage | 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% |
| Foreign Travel Emergency | ![]() |
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| Monthly Rates & Brochures | K | L |
| Choosing a Medigap Policy | ||
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Prepared for Sorin Munteanu Zip code: 91710 Age: 65 |
| Select all that apply |
If you are new to Medicare the following monthly discounts
are available for your first year of coverage |
| Contact us |
| (714) 921-9214 |
| Info@MojiHealthInsurance.Com |
| CA Ins Lic 0D57926 |