

| Part A Hospital Services | 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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| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | ![]() |
| Skilled nursing facility coinsurance | ![]() |
| 3 Pints of (unreplaced) blood | ![]() |
| Part B Services | N |
| Part B Annual Deductible ($240) | |
| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | 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 |
|
| Additional Features | N |
| Out of Pocket Limit | NA |
| Hospice coverage | ![]() |
| Foreign Travel Emergency | ![]() |
| Monthly Rates & Brochures | N |
| Anthem | 328.84 |
| Blue Shield | 415 |
| Health Net | 326.00 |
| Humana Achieve | 260.42 |
| Physicians Mutual | 279.95 |
| UHC | 314.68 |
| Choosing a Medigap Policy | |
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Prepared for
Zip code: 92253 Age: 85 |
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UHC rates based on Part B effective 10 or more years
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