

| Part A Hospital Services | A | 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) |
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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 | A | F | G | 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 | A | F | G | N |
| Out of Pocket Limit | NA | NA | NA | NA |
| Hospice coverage | ![]() |
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| Foreign Travel Emergency | ![]() |
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| Monthly Rates & Brochures | A | F | G | N |
| Anthem | 179.84 | S: 312.76 I: Additional benefits included with Anthem Innovative plan rider
|
223.92 | 241.07 |
| Blue Shield to 6/30/2024 | 153.00 | 262.00 | S: 215.00 Extra Rider
E: 230.00 |
194 |
| Health Net | 180.00 | S: 257.00 Additional benefits included with Health Net Innovative plan rider
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S: 229.00 Additional benefits included with Health Net Innovative plan rider
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194.00 |
| Humana Achieve to 7/31/2024 | 171.81 | 209.60 | 180.86 | 141.56 |
| ManhattanLife | 222.00 | 273.92 | 223.17 | 172.42 |
| UHC to 5/31/2024 | 144.55 | 245.86 | 191.75 | 162.12 |
| Choosing a Medigap Policy | ||||
| ManhattanLife: Add $25 application fee. | ||||
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Prepared for
Zip code: 92804 Age: 70 |
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Anthem rates reflect $2 automatic checking discount
Blue Shield rates reflect $3 automatic checking discount
Humana Achieve rates 12% household discount Humana Achieve rates reflect $2 automatic checking discount
UHC rates based on Part B effective less than 10 years UHC rates reflect $2 automatic checking discount
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