2016 Medicare Standard Supplement (Medigap) Plans (For Ages 65 and Older)

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1 PART A HOSPITALIZATION & SNF A B C D F F(HD) 1 G K L M N Hospital Deductible: Day 1 of Benefit Period $1,288 $1,288 $0 $0 $0 $0 $0 $0 $644 $322 $644 $0 Hospital Coinsurance: Days 1-60 $0/D $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Hospital Coinsurance: Days $322/D $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Hospital Coinsurance: Days $644/D $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Hospital Coinsurance: Days All costs $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Skilled Nursing Coinsurance: Days 1-20 $0/D $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Skilled Nursing Coinsurance: Days $161/D $161/D $161/D $0 $0 $0 $0 $0 $81/D $40/D $0 $0 Home Health Care Costs: $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Blood - First 3 Units as Inpatient: Copay/Yr. $600 5 $0 $0 $0 $0 $0 $0 $0 $300 $150 $0 $0 Blood - Additional Units as Inpatient $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 PART B OUTPATIENT & MEDICAL Part B Deductible: Annually $166 $166 $166 $0 $166 $0 $0 $166 $166 $166 $166 $166 Part B Medical Coinsurance 20% $0 $0 $0 $0 $0 $0 $0 10% 5% 0% $20 2 Part B Excess Charge (Non-particip. Dr.) +15% +15% +15% +15% +15% $0 $0 $0 +15% +15% +15% +15% Clinical Lab Tests: Coinsurance $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Blood - First 3 Units as Outpatient $600 5 $0 $0 $0 $0 $0 $0 $0 $300 $150 $0 $0 Blood - Additional Units as Outpatient $40 $0 $0 $0 $0 $0 $0 $0 $20 $10 $0 $0 NON-MEDICARE BENEFITS Foreign Travel Emergency Care All Costs All Costs All Costs 20% 3 20% 3 20% 3 20% 3 20% 3 All Costs All Costs 20% 3 20% 3 OTHER COSTS 2016 Medicare Standard Supplement (Medigap) Plans (For Ages 65 and Older) Medicare Cost Sharing Your Share Your Obligation with a Standardized Medigap Supplement Plan You pay deductible, then you pay $0 $2,180 1 Maximum you pay, then you pay $0 $4,960 $2,480 Footnotes: 1 - High Deductible Plan. You pay all Gap costs not paid by Medicare until the deductible amount is met before any payment is made by the policy. 2 - Plan pays all of Part B coinsurance except for a copayment of up to $20 for some office visits and up to a $50 copayment for ER visits that do not result in admission. 3 - Within 60 days from the start of your trip. $250 Deductible per year and $50,000 Lifetime limit. 4 - Using Lifetime Reserve of 60 days. 5 - Approximate costs for blood cchicap 12/1/15 Page 1 `

2 Medicare Supplement (Medigap) Plans Notes and Rating Methodology What types of Medigap policies insurance companies sell? Insurance companies selling Medigap policies are required to make Plan A available. If they offer any other Medigap plan, they must also offer either Medigap Plan C or Plan F. Insurance companies that sell Medigap policies don't have to offer every Medigap policy. Each insurance company decides which Medigap policies it wants to sell. Waiting Period for Pre-Existing Condition : A period of six months or less during which a company can refuse to pay claims for a health condition that was treated in six months prior to purchasing a policy. In most cases, a person can use previous health coverage to shorten or eliminate the waiting period. Rating Methodology Each insurance company decides how it will set the price, or premium for its Medigap policies. Medigap policies can be priced or "rated" in three ways: AA- Attained Age: Your premium will increase as you grow older. Additional increases due to higher medical costs or higher than expected claim costs are also possible. For example, if you buy a policy at age 65, when you turn 70, you will pay whatever the company is charging for a person 70 years old. However, any rate increase that occurs must apply to the entire class of policyholders in which you are categorized, not just to you as an individual. Most companies in this guide use the Attained Age Rating Method. IA - Issue Age: Your premium will always be based on your age at the time you purchased the plan. Any increases will be due to higher medical costs or higher than expected claim costs for the entire class of policyholders you are in. Even though you will have increases in your policy premium, the premium will not increase just because you are growing older. CR - No Age (Community) Rating: The premium for a specific policy is the same for everyone over the age of 65, regardless of their age. The only company using this rating methodology is United Healthcare (UHC) through AARP. UHC utilizes a two-tiered community rating, which offers a lower premium for people who apply for a Medigap policy within the first 36 months of their enrollment in Part B of Medicare. Other discounts are offered as well. These charts are provided as a convenience. The Health Insurance Counseling and Advocacy Program (HICAP) makes no claims as to the listed insurers financial status, reputation, sales practices or status in the market place. We make no claims on the value of products sold by these companies or that this chart is a complete listing of all insurers available or fully accurate. Premiums listed were extracted from the California Department of Insurance website or the Plan Web Site. Premiums are for Central Contra Costa County but may vary by zip code and are for individual plans unless noted. Always check with the insurance company for complete information. HICAP does not endorse any specific health insurer. The production of this document was supported by a federal grant from the Administration for Community Living (ACL). Its contents are solely the responsibility of Contra Costa HICAP and do not necessarily represent the official views of ACL. cchicap 12/1/2015 Page 2

3 Medicare Supplement (Medigap) Plans Contra Costa County Monthly Rates at Age 65 (by price of plan F) Name A B C D F F (HD) G K L M N METHOD Everence* $ $126 - $ $87 AA Continental Life $93 $ $137 $49 $ $92 AA USAA Life Insurance* $ $ $93 AA STATE FARM MUTUAL $78 - $141 - $ AA Blue Shield of Ca $97 - $133 $112 $143 $48 - $ $91 AA AARP / United* $90 $122 $144 $145 $51 $79 $99 CR Anthem Blue Cross $ $ $103 AA Globe Life $90 $131 $146 - $ AA Health Net Life $103 - $147 - $147 $62 $135 $78 $106 $123 - AA Combined Insurance Co $ $ $111 AA Individual Assurance Co $ $148 - $ $107 AA Loyal American Life $ $149 - $ $102 AA Oxford Life Insurance $ $ $100 AA Mutual Of Omaha $ $150 - $ AA Thrivent Financial* $119 $126 $156 $133 $153 $38 $131 - $97 $122 - IA Aetna Life Insurance Co $135 $ $163 - $ $107 AA United American $110 $151 $185 $171 $171 $31 $158 $102 $144 - $148 AA Colonial Penn Life $101 $ $176 $33 $134 $50 $97 $118 $80 AA Sterling Life Insurance $ $ $ $130 AA Humana $134 $146 $177 - $181 $56 - $78 $112 - $108 AA Standard Life $153 $159 $188 $178 $189 $25 $ $139 AA Gerber Life Insurance $ $193 - $ AA Thrivent Financial* $142 $160 $208 $184 $204 $54 $180 - $131 $166 - AA Sentinel Security Life $149 $164 $203 $164 $ $135 AA Liberty National Life $135 $ $208 $ $158 AA Physicians Mutual $ $275 $49 $ $163 AA Physicians Mutual $ $321 $62 $ $199 IA Notes: * - Some form of Membership required CCHICAP 12/1/15 Page 3 Sample Premiums as of 9/1/15 from CA Deptartment of Insurance or WEB based quotes direct from Insurance Companies.

4 Medicare Supplement (Medigap) Plans Contra Costa County Monthly Rates For Ages 65 and Older Age A B C D F F (HD) 1 G K L M N WAIT METHOD AARP/United Health Care (800) Must be member of AARP Aetna Life Insurance (888) Anthem Blue Cross of California aka California Physicians Service (800) Blue Shield of California (800) Colonial Penn Life Insurance (800) Combined Insurance of America (800) Continental Life of Brentwood, TN (888) Everence Association, Inc. (800) must be a member of Menonite fraternal org. Gerber Life Insurance (877) $90 $122 $144 $145 $51 $79 $99 0 CR CR CR CR 65 $135 $ $163 - $ $ days AA 70 $162 $ $199 - $ $ days AA 75 $186 $ $237 - $ $ days AA 80 $202 $ $266 - $ $ days AA 65 $ $ $ days AA days AA days AA days AA 65 $97 - $133 $112 $143 $48 - $ $91 0 AA AA AA AA 65 $101 $ $176 $33 $134 $50 $97 $118 $80 0 AA AA AA AA 65 $ $ $111 0 AA AA AA AA 65 $93 $ $137 $49 $ $92 0 AA $112 0 AA $138 0 AA $162 0 AA 65 $ $126 - $ $87 0 AA AA AA AA 65 $ $193 - $ AA AA AA AA Sample Premiums as of 9/1/15 from CA Deptartment of Insurance or WEB based quotes direct from Insurance Companies. cchicap 12/1/15 Page 1

5 Age A B C D F F (HD) 1 G K L M N WAIT METHOD Globe Life and Accident Insurance (800) Health Net Life Insurance (800) Humana Insurance (888) Individual Assurance (888) Liberty National Life Insurance (800) Loyal American (866) Mutual of Omaha Life Insurance (800) Oxford Life Insurance (800) Physicians Mutual Insurance Co. (800) Physicians Mutual Insurance Co. (800) $90 $131 $146 - $ days AA days AA days AA days AA 65 $103 - $147 - $147 $62 $135 $78 $106 $123-0 AA AA AA AA 65 $134 $146 $177 - $181 $56 - $78 $112 - $ days AA $67 - $93 $134 - $ days AA $79 - $109 $158 - $ days AA $91 - $126 $182 - $ days AA 65 $ $148 - $ $107 0 AA AA AA AA 65 $135 $ $208 $ $ days AA $ $ days AA $ $ days AA $ $ days AA 65 $ $149 - $ $ days AA days AA days AA days AA 65 $ $150 - $ AA $ AA $ AA $ AA 65 $ $ $100 0 AA AA AA AA 65 $ $275 $49 $ $163 0 AA $62 $ $199 0 AA $79 $ $245 0 AA $98 $ $290 0 AA 65 $ $321 $62 $ $199 0 IA IA IA IA Sample Premiums as of 9/1/15 from CA Deptartment of Insurance or WEB based quotes direct from Insurance Companies. cchicap 12/1/15 Page 2

6 Age A B C D F F (HD) 1 G K L M N WAIT METHOD Sentinal Security Life Insurance (800) Standard Life and Accident Insurance (888) State Farm Mutual Automobile Insurance Local Agent Sterling Life Insurance (800) Thrivent Financial For Lutherans Must be member of Thrivent Financial Thrivent Financial For Lutherans Must be member of Thrivent Financial United American Insurance (800) USAA Life Insurance (800) Must be member 65 $149 $164 $203 $164 $ $135 0 AA $155 0 AA $177 0 AA $199 0 AA 65 $153 $159 $188 $178 $189 $25 $ $139 0 AA AA AA AA 65 $78 - $141 - $ AA AA AA AA 65 $ $ $ $130 0 AA $142 $160 $208 $184 $204 $54 $180 - $131 $166-0 AA $64 $209 - $152 $192-0 AA $74 $241 - $174 $219-0 AA $85 $270 - $195 $244-0 AA 65 $119 $126 $156 $133 $153 $38 $131 - $97 $122-0 IA IA IA IA 65 $110 $151 $185 $171 $171 $31 $158 $102 $144 - $ days AA $41 $207 $134 $190 - $ days AA $53 $242 $148 $210 - $ days AA $63 $270 $154 $218 - $ days AA 65 $ $ $93 0 AA AA AA AA Sample Premiums as of 9/1/15 from CA Deptartment of Insurance or WEB based quotes direct from Insurance Companies. cchicap 12/1/15 Page 3

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