| 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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$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 |
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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 |
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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 | |
$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 |
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| 3 Pints of (unreplaced) blood | |
$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 |
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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 | |
$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 |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | F | F-ded | G | G-ded | N |
| Anthem | S: 219.32 I: Additional benefits included with Anthem Innovative plan rider
|
159.63 | 165.15 | ||
| Blue Shield eff 7/1/2024 | 197.00 | S: 147.00 Extra Rider
E: 164.00 |
866 | ||
| Blue Shield to 6/30/2024 | 182.00 | S: 136.00 Extra Rider
E: 152.00 |
134 | ||
| Health Net | S: 190.00 Additional benefits included with Health Net Innovative plan rider
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82.00 | S: 170.00 Additional benefits included with Health Net Innovative plan rider
|
68.00 | 135.00 |
| Humana Achieve to 7/31/2024 | 171.20 | 148.57 | 50.24 | 116.28 | |
| Humana Achieve eff 8/1/2024 | 183.91 | 159.58 | 50.24 | 116.28 | |
| Physicians Mutual | 193.59 | 169.22 | 141.02 | ||
| United American | 248.00 | 43.00 | 201.00 | 43.00 | 165.00 |
| UHC to 5/31/2024 | 175.68 | 137.28 | 116.32 | ||
| UHC eff 6/1/2024 | 196.16 | 153.44 | 129.92 |
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Prepared for
Zip code: 94956 Age: 65 |
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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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