ZapIndex

Part A Hospital Services	G	N
The Part A deductible is $1676 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 ($1676)
The inpatient deductible is $1676 for each benefit period Days 1-60: Medicare covers 100% Days 61-90: You are responsible for $408 per day Days 91 until 60 day lifetime reserve is used up: Your responsibility is $826 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	G	N
Part B Deductible ($257)
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	G	N
Out of Pocket Limit	NA	NA
Hospice coverage
Foreign Travel Emergency
Monthly Rates & Brochures	G	N
Aflac eff 7/1/2025HH	270.88	204.40
Anthem CKHH	274.01	300.27
Blue Shield to 6/30/2025 CKHH	S: 277.00 Note: Silver Sneakers gym membership is included with all Blue Shield plans. Additonal benefits with Blue Shield Extra Rider Foreign Travel - Not covered by Medicare $250 annual deductible, 80% coverage, $50,000 lifetime max (Click the Brochure link, see page 20) Physician Consultation by Phone or Video Through Teledoc No charge (see brochure page 20) Over-the-Counter Items through CVS Up to $100 allowance per quarter (see brochure page 20) Accupuncture and Chiropractic Services (provided by AHS provider network) Up to 20 visits per year, plan pays 100%, see page 21 in brochure for details Vision Coverage (provided by Vision Service Plan) Exam every 12 months, eyeglasses every 24 months, click the brochure link for details (see page 21) Hearing Aid Services (provided by Epic Hearing Healthcare) Routine hearing exams, copayments for hearing aids, see page 23 of brochure for details E: 294.00	257
Blue Shield CKHH	S: 309.00 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: 328.00	274
Cigna HH	278.70	226.10
Continental (Aetna) eff 9/1/2025 HH	371.77	284.64
Health Net	S: 288.00 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: 290.00	250.00
Humana	416.80	307.84
United American	360.00	306.00
UHC CKHH	276.54	234.52
United World Life CKHH	305.94	211.93
Choosing a Medigap Policy
Continental: Add $20 application fee.

Prepared for
Zip code: 92804
Age: 73

UHC rates based on Part B effective less than 10 years