Part A Hospital Services A B C D F F-ded G G-ded K L M N
The Part A deductible is $1736 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 facility
Part A Deductible ($1736)

$2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 in a calendar year
After that coverage is 100%
after
ded
$2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 in a calendar year
After that coverage is 100%
after
ded
  • The inpatient deductible is $1736 for each benefit period
  • Days 1-60: Medicare covers 100%
  • Days 61-90: You are responsible for $434 per day
  • Days 91 until 60 day lifetime reserve is used up: Your responsibility is $868 per day
  • Beyond lifetime reserve: You are responsible for all costs incurred
Hospital Coinsurance
$2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 in a calendar year
After that coverage is 100%
after
ded
$2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 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 year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%
Plan covers 50% Part A deductible50%
Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage
Skilled nursing facility coinsurance

$2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 in a calendar year
After that coverage is 100%
after
ded
$2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 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 year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%

3 Pints of (unreplaced) blood $2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 in a calendar year
After that coverage is 100%
after
ded
$2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 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 year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%
Part B Services A B C D F F-ded G G-ded K L M N
Part B Deductible ($283)









Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance $2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 in a calendar year
After that coverage is 100%
after
ded
$2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 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 year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%
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 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 $2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 in a calendar year
After that coverage is 100%
after
ded
$2950 annual deductible applies
You pay all Medicare deductibles, copays and coinsurance until you spend $2950 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 year
50%
Plan covers 75% of your out of pocket expenses
Your share is capped at $2560 per year
75%
Foreign Travel Emergency


Monthly Rates & Brochures A B C D F F-ded G G-ded K L M N
Aflac eff 7/1/2025 313.91


359.19
317.08



237.94
Anthem eff 3/1/2026 255.17


S: 481.80
I: Additional benefits included with Anthem Innovative plan rider
  • Vision Benefits
  • Routine eye exam In network: No Charge Out of network: $35 Allowance
  • Eyeglass Frames In network: $100 allowance Out of network: $45 Allowance
  • Eyeglass Lenses
    • Single vision - In network:100% coverage after $25 copay Out of network:$25 benefit after $25 copay
    • Bifocal - In network:100% coverage after $25 copay Out of network:$40 benefit after $25 copay
    • Trifocal or Lenticular - In network:100% coverage after $25 copay Out of network:$55 benefit after $25 copay
  • Contact Lenses In network: $100 allowance Out of network: $80 Allowance
  • Hearing Benefits Coverage through Hearing Care Solutions
  • Hearing exam: 100% coverage
  • Hearing aids: Coverage allowance up to $750 per year
  • Other Innovative Plan Benefits
  • Nurse help line: Speak with a Registered nurse about health related questions
  • Other Benefits (included with both Standard and Innovative Plans)
  • SilverSneakers gym membership
  • See page 21 or 22 in Anthem brochure for details
492.33

364.15



399.24
Anthem to 2/28/2026 255.17


S: 444.72
I: Additional benefits included with Anthem Innovative plan rider
  • Vision Benefits
  • Routine eye exam In network: No Charge Out of network: $35 Allowance
  • Eyeglass Frames In network: $100 allowance Out of network: $45 Allowance
  • Eyeglass Lenses
    • Single vision - In network:100% coverage after $25 copay Out of network:$25 benefit after $25 copay
    • Bifocal - In network:100% coverage after $25 copay Out of network:$40 benefit after $25 copay
    • Trifocal or Lenticular - In network:100% coverage after $25 copay Out of network:$55 benefit after $25 copay
  • Contact Lenses In network: $100 allowance Out of network: $80 Allowance
  • Hearing Benefits Coverage through Hearing Care Solutions
  • Hearing exam: 100% coverage
  • Hearing aids: Coverage allowance up to $750 per year
  • Other Innovative Plan Benefits
  • Nurse help line: Speak with a Registered nurse about health related questions
  • Other Benefits (included with both Standard and Innovative Plans)
  • SilverSneakers gym membership
  • See page 21 or 22 in Anthem brochure for details
441.16

317.78



348.43
Blue Shield 242.00


About Blue Shield Plan F
Blue Shield no longer sells Standard plan F
This quote refelects the rate for Plan F Extra
Plan F Extra includes all Plan F Standard benefits plus additional "Extra" benefits

About Blue Shield Plan F Extra rider

  • Basic gym access through sliver sneakers fitness program (silversneakers.com)
  • Personal Emergency Benefit provides access to help 24/7, at the push of a button
  • The vision benefit includes coverage for exams, frames and lenses
  • 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
448.00

S: 384.00
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: 402.00




331
HealthSpring 299.96


414.39
326.04 118.64


264.50
Continental (Aetna) 306.29 362.19

507.55 106.29 425.00



329.95
Health Net to 2/28/2026 257.00

339.00
S: 368.00
Additional benefits included with Health Net Innovative plan rider
  • Vision Benefits
  • Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
  • Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
  • Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
  • Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
  • Medically necessary contact Lenses - Up to $250 allowance
  • Hearing Benefits
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
    • Level 4 - You pay $1580
    • Level 3 - You pay $1125
    • Level 2 - You pay $700
    • Level 1 - You pay $0
See page 44 in Health Net brochure for details
I: 373.00
153.00
S: 327.00
Additional benefits included with Health Net Innovative plan rider
  • Vision Benefits
  • Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
  • Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
  • Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
  • Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
  • Medically necessary contact Lenses - Up to $250 allowance
  • Hearing Benefits
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
    • Level 4 - You pay $1580
    • Level 3 - You pay $1125
    • Level 2 - You pay $700
    • Level 1 - You pay $0
See page 44 in Health Net brochure for details
I: 336.00
147.00


291.00
Health Net eff 3/1/2025 280.00

369.00
S: 401.00
Additional benefits included with Health Net Innovative plan rider
  • Vision Benefits
  • Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
  • Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
  • Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
  • Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
  • Medically necessary contact Lenses - Up to $250 allowance
  • Hearing Benefits
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
    • Level 4 - You pay $1580
    • Level 3 - You pay $1125
    • Level 2 - You pay $700
    • Level 1 - You pay $0
See page 44 in Health Net brochure for details
I: 406.00
166.00
S: 356.00
Additional benefits included with Health Net Innovative plan rider
  • Vision Benefits
  • Routine Eye Exam (In network) - One vision exam every 12 months - $10 Copayment
  • Routine Eye Exam (Out of network) - One vision exam every 12 months - $45 Allowance
  • Frame & Lens Package - available from provider only (Once every 24 Months) - Up to $250 allowance
  • Contact Lenses (includes materials only - once every 24 months) - Up to $250 allowance
  • Medically necessary contact Lenses - Up to $250 allowance
  • Hearing Benefits
  • Routine Hearing Exam - One hearing exam every 12 months
  • Hearing Aid(s) - all sizes and styles offered by Hearing Care Solutions
    • Level 4 - You pay $1580
    • Level 3 - You pay $1125
    • Level 2 - You pay $700
    • Level 1 - You pay $0
See page 44 in Health Net brochure for details
I: 366.00
160.00


317.00
Humana407.52 443.35 541.60
138.08 476.49 124.07 220.74 318.98
351.86
Humana Achieve renewal only 244.28


303.65
267.75 90.41


218.44
United American to 4/30/2026 216.00 320.00 447.00 406.00 474.00 102.00 396.00 102.00 183.00 260.00
338.00
United American eff 5/1/2026 216.00 349.00 488.00 442.00 545.00 117.00 455.00 117.00 200.00 283.00
388.00
UHC 235.75 330.00 398.50
400.50
312.25

218.50
264.50
United World Life 293.07


521.92
426.32 94.66


275.63
Choosing a Medigap Policy
Continental: Add $20 application fee.
Prepared for
Zip code: 92804
Age: 77


Anthem rates reflect $2 automatic checking discount

Blue Shield rates reflect $3 automatic checking 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
Contact us
(800) 987-1234
michael@lujan.com
CA Ins Lic 1234567