| 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: 795.21 I: Additional benefits included with Anthem Innovative plan rider
|
570.79 | 614.14 | ||
| Blue Shield | 727.00 | S: 601.00 Extra Rider
E: 630.00 |
531 | ||
| Continental (Aetna) | 1,007.34 | 188.43 | 737.87 | 519.83 | |
| Health Net | S: 658.00 Additional benefits included with Health Net Innovative plan rider
|
284.00 | S: 519.00 Additional benefits included with Health Net Innovative plan rider
|
273.00 | 520.00 |
| Humana Achieve | 526.45 | 463.58 | 159.70 | 377.85 | |
| Physicians Mutual | 621.65 | 542.05 | 449.81 | ||
| United American to 4/30/2024 | 816.00 | 160.00 | 674.00 | 160.00 | 547.00 |
| United American eff 5/1/2024 | 868.00 | 176.00 | 725.00 | 176.00 | 602.00 |
| UHC to 5/31/2024 | 705.93 | 551.81 | 467.43 | ||
| UHC eff 6/1/2024 | 787.50 | 615.93 | 521.43 |
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Prepared for IRA MEYERS
Zip code: 90211 Age: 74 Spouse: 79 |
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Anthem rates reflect 5%
Enrollees who reside with another Anthem Blue Cross Medicare Supplement for subscribermember may qualify for a household discount
Humana Achieve rates 12% household discount UHC rates based on Part B effective 10 or more years UHC spousal rates based on Part B effective less than 10 years
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