

| Part A Hospital Services | 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) |
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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 | ![]() |
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| 3 Pints of (unreplaced) blood | ![]() |
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| Part B Services | 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 |
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| Additional Features | G | N |
| Out of Pocket Limit | NA | NA |
| Hospice coverage | ![]() |
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| Foreign Travel Emergency | ![]() |
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| Monthly Rates & Brochures | G | N |
| Choosing a Medigap Policy | ||
|
Prepared for Zip code: 92887 Age: 76 Spouse: 74 |
| Select all that apply |
If you are new to Medicare the following monthly discounts
are available for your first year of coverage |
| Contact us |
| (714) 325-2346 |
| sonia@jenseninsurances.com |
| CA Ins Lic 0G14152 |