| 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 in a calendar year After that coverage is 100% after ded |
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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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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$2800 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2800 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 | 141.09 | S: 236.01 I: Additional benefits included with Anthem Innovative plan rider
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| Blue Shield eff 7/1/2024 | 130.00 | 241.00 | ||||
| Continental (Aetna) | 135.70 | 171.68 | 240.65 | 44.98 | ||
| Health Net | 146.00 | S: 209.00 Additional benefits included with Health Net Innovative plan rider
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90.00 | |||
| Humana Achieve to 7/31/2024 | 159.03 | 194.55 | ||||
| ManhattanLife | 150.25 | 186.08 | ||||
| United American eff 5/1/2024 | 113.00 | 152.00 | 205.00 | 213.00 | 37.00 | 93.00 |
| UHC eff 6/1/2024 | 143.84 | 200.64 | 242.08 | 243.20 |
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Prepared for Bennett
Zip code: 93065 Age: 65 |
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UHC rates based on Part B effective less than 10 years
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