Part A Hospital Services A F G 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 facilityPart A Deductible ($1736)
  • 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
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 A F G N
Part B Deductible ($283)


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 A F G N
Out of Pocket Limit NA NA NA NA
Hospice coverage
Foreign Travel Emergency
Monthly Rates & Brochures A F G N
Blue Shield 228.00
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
391.00
S: 333.00
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: 350.00
 299
UHC 223.49 378.35 295.40 250.51
United World Life 272.74 485.69 396.70 256.50
United World Life 239.33 351.95 282.56 210.11
Choosing a Medigap Policy
Prepared for
Zip code: 92804
Age: 75

UHC rates based on Part B effective less than 10 years
Contact us
(800) 987-1234
michael@lujan.com
CA Ins Lic 1234567