| 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: 393.21 I: Additional benefits included with Anthem Innovative plan rider
|
286.16 | 296.04 | ||
| Blue Shield eff 7/1/2024 | 414.00 | S: 337.00 Extra Rider
E: 355.00 |
287 | ||
| Blue Shield to 6/30/2024 | 382.00 | S: 311.00 Extra Rider
E: 327.00 |
265 | ||
| Health Net | S: 320.00 Additional benefits included with Health Net Innovative plan rider
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138.00 | S: 286.00 Additional benefits included with Health Net Innovative plan rider
|
125.00 | 247.00 |
| Humana Achieve to 7/31/2024 | 257.36 | 228.17 | 76.83 | 188.92 | |
| Humana Achieve eff 8/1/2024 | 276.51 | 245.13 | 76.83 | 188.92 | |
| Physicians Mutual | 280.43 | 244.87 | 203.67 | ||
| United American | 352.00 | 76.00 | 295.00 | 76.00 | 247.00 |
| UHC to 5/31/2024 | 380.00 | 296.87 | 251.56 | ||
| UHC eff 6/1/2024 | 423.75 | 331.25 | 280.62 | ||
| Choosing a Medigap Policy | |||||
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Prepared for ROBERT SMAGULA
Zip code: 93109 Age: 80 |
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UHC rates based on Part B effective 10 or more years
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