| Part A Hospital Services | F | F-ded | G | G-ded | 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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$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 |
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$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 |
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$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 |
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$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 |
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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 | |
$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 |
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$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 |
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| 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 |
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$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 |
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| Part B Services | F | F-ded | G | G-ded | 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 | F-ded | G | G-ded | N |
| Out of Pocket Limit | NA | NA | NA | NA | 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 |
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$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 |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | F-ded | G | G-ded | N |
| Anthem | S: 396.05 I: Additional benefits included with Anthem Innovative plan rider
|
280.58 | 295.96 | ||
| Blue Shield | 505.00 | S: 418.00 Extra Rider
E: 434.00 |
343 | ||
| Continental (Aetna) | 416.25 | 77.97 | 304.88 | 229.16 | |
| Health Net | S: 380.00 Additional benefits included with Health Net Innovative plan rider
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164.00 | S: 337.00 Additional benefits included with Health Net Innovative plan rider
|
147.00 | 290.00 |
| Humana Achieve | 270.46 | 240.36 | 79.69 | 200.48 | |
| Physicians Mutual | 325.02 | 283.71 | 235.85 | ||
| United American to 4/30/2024 | 331.00 | 70.00 | 274.00 | 70.00 | 225.00 |
| United American eff 5/1/2024 | 352.00 | 76.00 | 295.00 | 76.00 | 247.00 |
| UHC to 5/31/2024 | 387.40 | 302.83 | 256.61 | ||
| UHC eff 6/1/2024 | 441.75 | 345.55 | 292.65 |
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Prepared for
Zip code: 92211 Age: 82 |
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Anthem rates reflect 10%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement member may qualify for a household discount for subscriber
Humana Achieve rates 12% household discount UHC rates based on Part B effective 10 or more years UHC rates reflect 7% You can take 7% off your monthly premiums if
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