| Part A Hospital Services | A | B | C | F | F-ded | K |
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| 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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
| 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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$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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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| 3 Pints of (unreplaced) blood | |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
| Part B Services | A | B | C | F | F-ded | K |
| 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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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
| 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 | A | B | C | F | F-ded | K |
| Out of Pocket Limit | NA | NA | NA | NA | NA | $5120 |
| Hospice coverage | |
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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 |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | B | C | F | F-ded | K |
| Anthem | 393.55 | S: 870.45 I: Additional benefits included with Anthem Innovative plan rider
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| Blue Shield to 6/30/2024 | 544.00 | 1,063.00 | ||||
| Continental (Aetna) | 315.21 | 398.59 | 558.36 | |||
| Health Net | 304.00 | S: 434.00 Additional benefits included with Health Net Innovative plan rider
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188.00 | |||
| Humana Achieve to 7/31/2024 | 313.83 | 428.21 | ||||
| ManhattanLife | 418.25 | 506.50 | ||||
| United American eff 5/1/2024 | 295.00 | 422.00 | 634.00 | 693.00 | 0.00 | |
| UHC to 5/31/2024 | 231.86 | 323.74 | 390.30 | 392.17 |
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Prepared for David Reisman
Zip code: 91344 Age: 61 |
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Humana Achieve rates 12% household discount UHC rates based on Part B effective less than 10 years
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