| Part A Hospital Services | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
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| 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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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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 | |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| 3 Pints of (unreplaced) blood | |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| Part B Services | A | B | C | D | F | F-ded | G | G-ded | K | L | M | 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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Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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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 | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Out of Pocket Limit | NA | NA | NA | NA | NA | NA | NA | NA | $5120 | $2560 | NA | NA |
| Hospice coverage | |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
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$2700 annual deductible applies You pay all Medicare deductibles, copays and coinsurance until you spend $2700 in a calendar year After that coverage is 100% after ded |
Plan covers 50% of your out of pocket expenses Your share is capped at $5120 per year50% |
Plan covers 75% of your out of pocket expenses Your share is capped at $2560 per year75% |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | A | B | C | D | F | F-ded | G | G-ded | K | L | M | N |
| Anthem | -2.00 | S: -2.00 I: Additional benefits included with Anthem Innovative plan rider
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-2.00 | |||||||||
| Blue Shield eff 7/1/2024 | -3.00 | -3.00 | S: -3.00 Extra Rider
E: -3.00 |
-3 | ||||||||
| Blue Shield to 6/30/2024 | -3.00 | -3.00 | S: -3.00 Extra Rider
E: -3.00 |
-3 | ||||||||
| Continental (Aetna) | 205.17 | 259.40 | 363.44 | 67.97 | 266.39 | 196.84 | ||||||
| Health Net | 0.00 | 0.00 | S: 0.00 Additional benefits included with Health Net Innovative plan rider
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0.00 | S: 0.00 Additional benefits included with Health Net Innovative plan rider
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0.00 | 0.00 | |||||
| Humana Achieve | -2.00 | -2.00 | -2.00 | -2.00 | -2.00 | |||||||
| ManhattanLife | 216.83 | 269.92 | 217.83 | 184.08 | ||||||||
| National Health Ins | 235.65 | 308.45 | 90.21 | 263.03 | 207.64 | |||||||
| Physicians Mutual | 211.40 | 268.01 | 233.42 | 193.34 | ||||||||
| United American to 4/30/2024 | 158.00 | 220.00 | 297.00 | 269.00 | 303.00 | 60.00 | 250.00 | 60.00 | 137.00 | 193.00 | 203.00 | |
| United American eff 5/1/2024 | 162.00 | 226.00 | 312.00 | 283.00 | 323.00 | 65.00 | 269.00 | 65.00 | 137.00 | 193.00 | 223.00 | |
| UHC to 5/31/2024 | 222.68 | 311.43 | 376.12 | 378.00 | 294.87 | 206.75 | 249.56 | |||||
| UHC eff 6/1/2024 | 248.62 | 347.68 | 419.87 | 421.75 | 329.25 | 230.50 | 278.62 |
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Prepared for sjp
Zip code: 92014 Age: 76 |
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Anthem rates reflect $2 automatic checking discount
Blue Shield rates reflect $3 automatic checking discount
Humana Achieve rates reflect $2 automatic checking discount
Physicians Mutual rates reflect $5 automatic checking discount
UHC rates based on Part B effective 10 or more years UHC rates reflect $2 automatic checking discount
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