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 61-90 $322/D $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Hospital Coinsurance: Days 91-150 4 $644/D $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Hospital Coinsurance: Days 151-516 4 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 21-100 $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 `
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
2015-16 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* $113 - - - $126 - $117 - - - $87 AA Continental Life $93 $117 - - $137 $49 $121 - - - $92 AA USAA Life Insurance* $109 - - - $141 - - - - - $93 AA STATE FARM MUTUAL $78 - $141 - $142 - - - - - - AA Blue Shield of Ca $97 - $133 $112 $143 $48 - $60 - - $91 AA AARP / United* $90 $122 $144 $145 $51 $79 $99 CR Anthem Blue Cross $100 - - - $146 - - - - - $103 AA Globe Life $90 $131 $146 - $147 - - - - - - AA Health Net Life $103 - $147 - $147 $62 $135 $78 $106 $123 - AA Combined Insurance Co $103 - - - $147 - - - - - $111 AA Individual Assurance Co $131 - - - $148 - $126 - - - $107 AA Loyal American Life $118 - - - $149 - $128 - - - $102 AA Oxford Life Insurance $139 - - - $149 - - - - - $100 AA Mutual Of Omaha $114 - - - $150 - $133 - - - - AA Thrivent Financial* $119 $126 $156 $133 $153 $38 $131 - $97 $122 - IA Aetna Life Insurance Co $135 $138 - - $163 - $140 - - - $107 AA United American $110 $151 $185 $171 $171 $31 $158 $102 $144 - $148 AA Colonial Penn Life $101 $131 - - $176 $33 $134 $50 $97 $118 $80 AA Sterling Life Insurance $156 - - - $177 - - $75 - - $130 AA Humana $134 $146 $177 - $181 $56 - $78 $112 - $108 AA Standard Life $153 $159 $188 $178 $189 $25 $179 - - - $139 AA Gerber Life Insurance $138 - - - $193 - $166 - - - - AA Thrivent Financial* $142 $160 $208 $184 $204 $54 $180 - $131 $166 - AA Sentinel Security Life $149 $164 $203 $164 $208 - - - - - $135 AA Liberty National Life $135 $184 - - $208 $33 - - - - $158 AA Physicians Mutual $147 - - - $275 $49 $187 - - - $163 AA Physicians Mutual $167 - - - $321 $62 $218 - - - $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.
2015-16 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) 523-5800 www.aarpmedicaresupplement.com Must be member of AARP Aetna Life Insurance (888) 624-6290 www.aetnamedicare.com Anthem Blue Cross of California aka California Physicians Service (800) 333-3883 www.anthem.com Blue Shield of California (800)-248-2341 www.blueshieldca.com Colonial Penn Life Insurance (800)-800-2254 www.bankerslife.com Combined Insurance of America (800)-544-5531 www.combinedinsurance.com Continental Life of Brentwood, TN (888) 624-6290 www.aetnaseniorproducts.com Everence Association, Inc. (800) 348-7468 www.everence.com must be a member of Menonite fraternal org. Gerber Life Insurance (877) 778-0839 www.gerberlife.com 65 $90 $122 $144 $145 $51 $79 $99 0 CR 70 110 148 175 176 61 96 120 0 CR 75 161 217 257 259 90 142 176 0 CR 80 161 217 257 259 90 142 176 0 CR 65 $135 $138 - - $163 - $140 - - - $107 163 days AA 70 $162 $169 - - $199 - $173 - - - $133 163 days AA 75 $186 $199 - - $237 - $208 - - - $160 163 days AA 80 $202 $222 - - $266 - $241 - - - $186 163 days AA 65 $100 - - - $146 - - - - - $103 60 days AA 70 122 - - - 178 - - - - - 126 60 days AA 75 148 - - - 217 - - - - - 153 60 days AA 80 179 - - - 262 - - - - - 185 60 days AA 65 $97 - $133 $112 $143 $48 - $60 - - $91 0 AA 70 126-171 146 185 67-78 - - 118 0 AA 75 183-244 207 268 98-112 - - 171 0 AA 80 203-278 238 297 108-130 - - 189 0 AA 65 $101 $131 - - $176 $33 $134 $50 $97 $118 $80 0 AA 70 124 159 - - 213 40 165 60 115 147 105 0 AA 75 151 193 - - 259 48 204 75 140 182 135 0 AA 80 176 224 - - 309 57 247 91 167 217 168 0 AA 65 $103 - - - $147 - - - - - $111 0 AA 70 134 - - - 192 - - - - - 145 0 AA 75 164 - - - 234 - - - - - 176 0 AA 80 185 - - - 265 - - - - - 199 0 AA 65 $93 $117 - - $137 $49 $121 - - - $92 0 AA 70 112 142 - - 165 59 146 - - - $112 0 AA 75 137 173 - - 201 72 177 - - - $138 0 AA 80 157 198 - - 231 83 204 - - - $162 0 AA 65 $113 - - - $126 - $117 - - - $87 0 AA 70 137 - - - 158-148 - - - 109 0 AA 75 169 - - - 189-176 - - - 135 0 AA 80 198 - - - 220-205 - - - 161 0 AA 65 $138 - - - $193 - $166 - - - - 0 AA 70 163 - - - 229-197 - - - - 0 AA 75 181 - - - 258-223 - - - - 0 AA 80 192 - - - 280-243 - - - - 0 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
Age A B C D F F (HD) 1 G K L M N WAIT METHOD Globe Life and Accident Insurance (800) 801-6831 www.globecaremedsupp.com Health Net Life Insurance (800) 926-4178 www.healthnet.com Humana Insurance (888) 310-8482 www.humana.com Individual Assurance (888) 524-3629 www.iaclife.com Liberty National Life Insurance (800) 331-2512 www.libertynational.com Loyal American (866) 459-4272 www.loyalamerican.com Mutual of Omaha Life Insurance (800) 667-2937 www.mutualofomaha.com Oxford Life Insurance (800) 308-2318 www.oxfordlife.com Physicians Mutual Insurance Co. (800) 228-9100 www.physiciansmutual.com Physicians Mutual Insurance Co. (800) 228-9100 www.physiciansmutual.com 65 $90 $131 $146 - $147 - - - - - - 60 days AA 70 122 166 181-182 - - - - - - 60 days AA 75 133 195 210-212 - - - - - - 60 days AA 80 134 199 226-227 - - - - - - 60 days AA 65 $103 - $147 - $147 $62 $135 $78 $106 $123-0 AA 70 124-177 - 177 74 163 94 127 149-0 AA 75 154-220 - 220 92 202 117 158 185-0 AA 80 173-247 - 247 104 227 131 178 207-0 AA 65 $134 $146 $177 - $181 $56 - $78 $112 - $108 90 days AA 70 160 174 212-216 $67 - $93 $134 - $129 90 days AA 75 189 205 250-255 $79 - $109 $158 - $152 90 days AA 80 218 237 288-294 $91 - $126 $182 - $176 90 days AA 65 $131 - - - $148 - $126 - - - $107 0 AA 70 147 - - - 166-143 - - - 120 0 AA 75 169 - - - 193-169 - - - 142 0 AA 80 189 - - - 222-195 - - - 166 0 AA 65 $135 $184 - - $208 $33 - - - - $158 60 days AA 70 171 236 - - 268 $44 - - - - $208 60 days AA 75 192 269 - - 311 $56 - - - - $245 60 days AA 80 196 282 - - 347 $69 - - - - $278 60 days AA 65 $118 - - - $149 - $128 - - - $102 90 days AA 70 138 - - - 174-152 - - - 121 90 days AA 75 159 - - - 202-180 - - - 143 90 days AA 80 179 - - - 235-210 - - - 168 90 days AA 65 $114 - - - $150 - $133 - - - - 0 AA 70 125 - - - 164 - $146 - - - - 0 AA 75 146 - - - 192 - $171 - - - - 0 AA 80 171 - - - 225 - $200 - - - - 0 AA 65 $139 - - - $149 - - - - - $100 0 AA 70 164 - - - 177 - - - - - 118 0 AA 75 195 - - - 208 - - - - - 140 0 AA 80 214 - - - 238 - - - - - 162 0 AA 65 $147 - - - $275 $49 $187 - - - $163 0 AA 70 174 - - - 322 $62 $219 - - - $199 0 AA 75 194 - - - 386 $79 $263 - - - $245 0 AA 80 211 - - - 448 $98 $305 - - - $290 0 AA 65 $167 - - - $321 $62 $218 - - - $199 0 IA 70 187 - - - 373 76 254 - - - 236 0 IA 75 203 - - - 426 94 290 - - - 276 0 IA 80 220 - - - 482 114 328 - - - 308 0 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
Age A B C D F F (HD) 1 G K L M N WAIT METHOD Sentinal Security Life Insurance (800) 247-1423 www.sslco.com Standard Life and Accident Insurance (888) 350-1488 www.slaico.com State Farm Mutual Automobile Insurance Local Agent www.statefarm.com Sterling Life Insurance (800) 688-0010 www.sterlinginsurance.com Thrivent Financial For Lutherans 1-800-847-4836 www.thrivent.com/insurance/medsupp Must be member of Thrivent Financial Thrivent Financial For Lutherans 1-800-847-4836 www.thrivent.com/insurance/medsupp Must be member of Thrivent Financial United American Insurance (800) 331-2512 www.unitedamerican.com USAA Life Insurance (800) 531-8722 www.usaa.com Must be member 65 $149 $164 $203 $164 $208 - - - - - $135 0 AA 70 171 188 233 189 238 - - - - - $155 0 AA 75 191 213 265 215 271 - - - - - $177 0 AA 80 209 236 296 241 303 - - - - - $199 0 AA 65 $153 $159 $188 $178 $189 $25 $179 - - - $139 0 AA 70 158 164 193 183 194 26 184 - - - 143 0 AA 75 182 190 224 212 225 30 213 - - - 166 0 AA 80 214 223 262 249 264 35 250 - - - 194 0 AA 65 $78 - $141 - $142 - - - - - - 0 AA 70 98-177 - 179 - - - - - - 0 AA 75 114-206 - 208 - - - - - - 0 AA 80 128-231 - 233 - - - - - - 0 AA 65 $156 - - - $177 - - $75 - - $130 0 AA 70 185 - - - 214 - - 92 - - 159 0 75 214 - - - 256 - - 111 - - 192 0 80 247 - - - 331 - - 151 - - 256 0 65 $142 $160 $208 $184 $204 $54 $180 - $131 $166-0 AA 70 159 181 239 213 234 $64 $209 - $152 $192-0 AA 75 171 200 272 244 266 $74 $241 - $174 $219-0 AA 80 177 214 304 274 297 $85 $270 - $195 $244-0 AA 65 $119 $126 $156 $133 $153 $38 $131 - $97 $122-0 IA 70 141 152 185 160 182 47 158-118 146-0 IA 75 162 179 220 194 216 58 191-142 176-0 IA 80 173 199 258 230 253 70 227-169 207-0 IA 65 $110 $151 $185 $171 $171 $31 $158 $102 $144 - $148 60 days AA 70 139 193 238 224 220 $41 $207 $134 $190 - $194 60 days AA 75 156 220 276 263 255 $53 $242 $148 $210 - $229 60 days AA 80 159 230 307 294 284 $63 $270 $154 $218 - $259 60 days AA 65 $109 - - - $141 - - - - - $93 0 AA 70 127 - - - 166 - - - - - 109 0 AA 75 152 - - - 198 - - - - - 130 0 AA 80 176 - - - 229 - - - - - 150 0 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