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# Plan G
HospitalizationYou Pay $0
Skilled Nursing Facility CareYou Pay $0
Hospice CareYou Pay $0
Home Health Care Medicare-Approved ServicesYou Pay $0
Medical Expenses (In or Out of the hospital treatment)You Pay $198
Clinical Laboratory Services- Test for Diagnostic ServicesYou Pay $0
Foreign Travel EmergencyYou Pay $250, then 20% and amounts over
the $50,000 lifetime Maximum
Accupunture ServicesNot Covered
Plan detail information PDF
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〈Anthem Blue Cross〉
# Plan G Extra
HospitalizationYou Pay $0
Skilled Nursing Facility CareYou Pay $0
Hospice CareYou Pay $0
Home Health Care Medicare-Approved ServicesYou Pay $0
Medical Expenses (In or Out of the hospital treatment)You Pay $198
Clinical Laboratory Services- Test for Diagnostic ServicesYou Pay $0
Foreign Travel EmergencyYou Pay $250, then 20% and amounts over
the $50,000 lifetime Maximum
Over-the-counter Items through CVSUp to $100 one-time use per quarter
Hearing AidsCovered
Acupuncture ServicesNot Covered
Free Extra BenefitsBasic Gym Access
Plan detail information PDF
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〈Blue Shield〉
# Plan G
HospitalizationYou Pay $0
Skilled Nursing Facility CareYou Pay $0
Hospice CareYou Pay $0
Home Health Care Medicare-Approved ServicesYou Pay $0
Medical Expenses (In or Out of the hospital treatment)You Pay $198
Clinical Laboratory Services- Test for Diagnostic ServicesYou Pay $0
Foreign Travel EmergencyYou Pay $250, then 20% and amounts over
the $50,000 lifetime Maximum
Acupuncture ServicesNot Covered
Plan detail information PDF
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〈UHC AARP〉
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