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Part A Hospital Services	F	G	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)
The inpatient deductible is $1632 for each benefit period Days 1-60: Medicare covers 100% Days 61-90: You are responsible for $408 per day Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day Beyond lifetime reserve: You are responsible for all costs incurred Hospital Coinsurance
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	F	G	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	F	G	N
Out of Pocket Limit	NA	NA	NA
Hospice coverage
Foreign Travel Emergency
Monthly Rates & Brochures	F	G	N
Anthem CKHH	S: 615.11 I: Additional benefits included with Anthem Innovative plan rider Vision: Routine eye exam $25 copay, $100 frame allowance Hearing: Hearing exam every 12 months, $750 annual allowance for hearing aids Nurse help line: Speak with a Registered nurse about health related questions SilverSneakers gym membership 579.62	447.65	463.12
Blue Shield eff 7/1/2024 CKHH	532.89	S: 446.40 Extra Rider Basic gym access through sliver sneakers fitness program (silversneakers.com) Personal emergency response system Physician consultation by phone or video through Teladoc Over the counter items through CVS (Up to $100 one time use per quarter allowance) The vision benefit includes coverage for exams, frames and lenses ($100 frame allowance) Hearing aid benefit includes an annual hearing aid test and coverage for Vista brand mid-level and premium-level hearing aids for a low copay Acupuncture and chiropractic, up to 20 combined visits per calendar year Identity theft protection E: 478.02	431.52
Health Net	S: 532.00 Additional benefits included with Health Net Innovative plan rider Routine Hearing Exam - One hearing exam every 12 months Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid Routine Eye Exam - One vision exam every 12 months Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months I: 544.00	S: 428.00 Additional benefits included with Health Net Innovative plan rider Routine Hearing Exam - One hearing exam every 12 months Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid Routine Eye Exam - One vision exam every 12 months Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months I: 463.00	397.00
United American eff 5/1/2024	810.00	672.00	555.00
UHC eff 6/1/2024 CKHH	586.18	458.51	388.24

Part A Hospital Services

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)

The inpatient deductible is $1632 for each benefit period
Days 1-60: Medicare covers 100%
Days 61-90: You are responsible for $408 per day
Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 per day
Beyond lifetime reserve: You are responsible for all costs incurred

Hospital Coinsurance

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

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

Out of Pocket Limit

Hospice coverage

Foreign Travel Emergency

Monthly Rates & Brochures

Anthem CKHH

S: 615.11
I: Additional benefits included with Anthem Innovative plan rider

Vision: Routine eye exam $25 copay, $100 frame allowance
Hearing: Hearing exam every 12 months, $750 annual allowance for hearing aids
Nurse help line: Speak with a Registered nurse about health related questions
SilverSneakers gym membership

579.62

447.65

463.12

Blue Shield eff 7/1/2024 CKHH

532.89

S: 446.40

Extra Rider

Basic gym access through sliver sneakers fitness program (silversneakers.com)
Personal emergency response system
Physician consultation by phone or video through Teladoc
Over the counter items through CVS (Up to $100 one time use per quarter allowance)
The vision benefit includes coverage for exams, frames and lenses ($100 frame allowance)
Hearing aid benefit includes an annual hearing aid test and coverage for Vista brand mid-level and premium-level hearing aids for a low copay
Acupuncture and chiropractic, up to 20 combined visits per calendar year
Identity theft protection

E: 478.02

431.52

Health Net

S: 532.00
Additional benefits included with Health Net Innovative plan rider

Routine Hearing Exam - One hearing exam every 12 months
Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid
Routine Eye Exam - One vision exam every 12 months
Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months

I: 544.00

S: 428.00
Additional benefits included with Health Net Innovative plan rider

Routine Hearing Exam - One hearing exam every 12 months
Hearing Aid(s) - includes fitting evaluation. $1000 maximum for two hearing aids (one pair) or $500 for one hearing aid
Routine Eye Exam - One vision exam every 12 months
Eyewear - Up to $250 allowance for frame and lens package once every 24 months or contact lens once every 12 months

I: 463.00

397.00

United American eff 5/1/2024

810.00

672.00

555.00

UHC eff 6/1/2024 CKHH

586.18

458.51

388.24

Select all that apply

Anthem $2 per month

Automatic Checking Withdrawal Discount

If you are new to Medicare the following monthly discounts
are available for your first year of coverage

Anthem Plan F: $20 Plans G: $25 per month
Blue Shield Plans A. F and G: $25 per month
Health Net All Plans: $30 per month
United Healthcare Plan G: $25 per month

Welcome to Medicare discount 2 party

Anthem Plan F rates reflect $20 Welcome to Medicare discount.

Anthem Plan F rates reflect $40 2 party Welcome to Medicare discount.

Anthem Plan G rates reflect $25 Welcome to Medicare discount.

Anthem Plan G rates reflect $50 2 party Welcome to Medicare discount.

Enrollees who live with another Anthem Medicare Supplement
member may qualify for a household discount.

For members with an original Anthem Blue Cross
effective date after 2/28/2023 the discount is 10%
For those with original effective dates between
6/1/2010 and 2/28/2023 the discount is 5%
The household discount is not available to persons
enrolled before 6/1/2010

Anthem household discount

Sp.

Anthem rates reflect $2 automatic checking discount.

Blue Shield Plan G rates reflect $25 Welcome to Medicare discount.

Blue Shield Plan G rates reflect $50 2 party Welcome to Medicare discount.

Blue Shield rates reflect $3 automatic checking discount.

Blue ShieldYou are eligible for a 7% household premium discount

if you reside with another person who is on the same Blue Shield Medicare Supplement plan
including same Dental plan.

Only one policy will be issued, the second party will be covered as a dependent. household discount (7%)

Continental Life You are be eligible for a 5% discount if you reside with another
person covered by Continental Life who is either
(a) your spouse;
(b) someone with whom you are in a civil union partnership;
(c) a permanent resident in your home.5% household discount

Health Net rates reflect $30 Welcome to Medicare discount.

Health Net rates reflect $60 2 party Welcome to Medicare discount.

Humana Achieve rates reflect $2 automatic checking discount.

Physicians Mutual rates reflect $5 automatic checking discount.

UHC Plan G rates reflect $25 Welcome to Medicare discount.

UHC Plan G rates reflect $50 2 party Welcome to Medicare discount.

United Healthcare rates reflect $2 automatic checking discount.

UHC/AARPYou can take 7% off your monthly premiums if

two or more members are enrolled under the same AARP membership number
and each is insured under an eligible AARP-branded supplemental insurance
policy insured by UnitedHealthcare Insurance Company.

household discount (7%)