Part A Hospital Services F F-ded G G-ded
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)		 $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
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
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
Part B Services F F-ded G G-ded
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
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 F F-ded G G-ded
Out of Pocket Limit NA NA 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
Foreign Travel Emergency
Monthly Rates & Brochures F F-ded G G-ded
Aflac eff 7/1/2025 359.19
317.08
Anthem eff 3/1/2026
S: 483.80
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
366.15
Anthem to 2/28/2026
S: 446.72
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
319.78
Blue Shield
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
451.00
S: 387.00
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: 405.00
Cigna 414.39
326.04 118.64
Continental (Aetna) 507.55 106.29 425.00
Health Net to 2/28/2026
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 detailsI: 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 detailsI: 336.00
 147.00
Health Net eff 3/1/2025
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 detailsI: 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 detailsI: 366.00
 160.00
Humana 138.08 476.49 124.07
United American to 4/30/2026 474.00 102.00 396.00 102.00
United American eff 5/1/2026 545.00 117.00 455.00 117.00
UHC 402.50
314.25
United World Life 521.92
426.32 94.66
Choosing a Medigap Policy
Continental: Add $20 application fee.
Prepared for
Zip code: 92804
Age: 77

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