| 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: 708.79 I: Additional benefits included with Anthem Innovative plan rider
|
508.77 | 547.39 | ||
| Blue Shield eff 7/1/2024 | 676.00 | S: 546.00 Extra Rider
E: 579.00 |
493 | ||
| Blue Shield to 6/30/2024 | 626.00 | S: 505.00 Extra Rider
E: 536.00 |
456 | ||
| Continental (Aetna) | 785.77 | 146.94 | 575.94 | 402.33 | |
| Health Net | S: 578.00 Additional benefits included with Health Net Innovative plan rider
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250.00 | S: 469.00 Additional benefits included with Health Net Innovative plan rider
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239.00 | 446.00 |
| Humana Achieve | 547.70 | 480.32 | 162.74 | 386.51 | |
| Physicians Mutual | 559.92 | 488.26 | 405.26 | ||
| United American to 4/30/2024 | 717.00 | 136.00 | 588.00 | 136.00 | 475.00 |
| United American eff 5/1/2024 | 763.00 | 148.00 | 632.00 | 148.00 | 522.00 |
| UHC to 5/31/2024 | 533.38 | 416.93 | 353.18 | ||
| UHC eff 6/1/2024 | 595.00 | 465.38 | 393.98 |
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Prepared for KENNETH BARTON & VIRGINIA
Zip code: 91307 Age: 78 Spouse: 67 |
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UHC rates based on Part B effective less than 10 years UHC spousal rates based on Part B effective less than 10 years
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