Part A Hospital Services F G G-ded 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)		 $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
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
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
Part B Services F G G-ded 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
 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 F G G-ded N
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
Foreign Travel Emergency
Monthly Rates & Brochures F G G-ded N
Aflac eff 7/1/2025 359.19 317.08
237.94
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
401.24
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
350.43
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
334
Cigna 414.39 326.04 118.64 264.50
Continental (Aetna) 507.55 425.00
329.95
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
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
 147.00 291.00
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
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
 160.00 317.00
Humana 476.49 124.07 351.86
United American to 4/30/2026 474.00 396.00 102.00 338.00
United American eff 5/1/2026 545.00 455.00 117.00 388.00
UHC 402.50 314.25
266.50
United World Life 521.92 426.32 94.66 275.63
Choosing a Medigap Policy
Continental: Add $20 application fee.

Prepared for
Zip code: 92804
Age: 77
Select all that apply
  • Anthem $2 per month
  • Blue Shield $3 per month
  • United Healthcare $2 per month
Automatic Checking Withdrawal Discount
If you are new to Medicare the following monthly discounts
are available for your first year of coverage
  • Anthem Plan F: $20 Plans G: $25 per month
  • Blue Shield Plans A. F and G: $25 per month
  • Health Net All Plans: $30 per month
  • United Healthcare Plan G: $25 per month
Welcome to Medicare discount 2 party
AflacAflac offers a 10% household premium discount
  • if you reside with your spouse or domestic partner
  • or you have been living with a family member who is age
    50 or older for at least 12 months
 household discount (10%)
Enrollees who live with another Anthem Medicare Supplement
member may qualify for a household discount.
  • For members with an original Anthem Blue Cross
    effective date after 2/28/2023 the discount is 10%
  • For those with original effective dates between
    6/1/2010 and 2/28/2023 the discount is 5%
  • The household discount is not available to persons
    enrolled before 6/1/2010
Anthem household discount
Blue ShieldYou are eligible for a 7% household premium discount
  • if you reside with another person who is on the same Blue Shield Medicare Supplement plan
  • including same Dental plan.
Only one policy will be issued, the second party will be covered as a dependent. household discount (7%)
HealthSpring HealthSpring
  • You are eligible for a 6% household you live with another person age 18 or over
  • You are eligible for a 11% discount if another person in your household has a HealthSpring Medicare Supplement plan
household discount
Continental LifeContinental Life offers a 5% household premium discount
  • if you are marriied and residing with your spouse who is also covered by Continental Life
  • you are in a civil union partnership with a person covered by Continental Life
  • a permanent resident in your home is also covered by Continental Life
 household discount (5%)
UHC/AARPYou can take 7% off your monthly premiums if
  • two or more members are enrolled under the same AARP membership number
  • and each is insured under an eligible AARP-branded supplemental insurance
    policy insured by UnitedHealthcare Insurance Company.
 household discount (7%)
Contact us
(800) 987-1234
michael@lujan.com
CA Ins Lic 1234567