

| Part A Hospital Services | A | B | K | M | 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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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 50% Part A deductible50% | ![]() |
| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | ![]() |
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| Skilled nursing facility coinsurance | 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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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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| Part B Services | A | B | K | M | N |
| Part B Annual Deductible ($240) | |||||
| 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% |
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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 | A | B | K | M | N |
| Out of Pocket Limit | NA | NA | $5120 | NA | NA |
| Hospice coverage | ![]() |
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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
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| Foreign Travel Emergency | ![]() |
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| Monthly Rates & Brochures | A | B | K | M | N |
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Prepared for Zip code: 94941 Age: 96 |
| Select all that apply |
If you are new to Medicare the following monthly discounts
are available for your first year of coverage |
| Contact us |
| (415) 492-0130 |
| katie@myhealthbroker.com Tiff: support@myhealthbroker.com |
| CA Ins Lic 6007844 |