Page 53 - Cover letter and evaluation for Peter Smith

11/27/2017 Your Medicare Health Plan Details
Plan Type: HMO
Plan Status: Approved by Medicare
Area: Clark and Nye counties

View plan website 
Important Note:
View Drug Benefit Summary

Provider Network: 1001-1500 physicians and providers.
View provider and physician network website 

View a chart on how an independent sales agent or broker would be compensated if they were to enroll you in a plan
for 2018

Costs

Monthly Premiums

2
Part B premium $134.00
View Part B premiums based on income
Plan premium $0.00

Health plan premium $0.00

Drug plan premium $0.00
Estimated Costs

*Inpatient care $4.00

*Outpatient prescription drugs $302.80

*Dental services $28.00

*All other services
$35.00
Total monthly estimated costs
$503.80

3
TOTAL ESTIMATED ANNUAL COSTS [?] $6,050
How are Out-of-Pocket costs calculated?

View estimated monthly Out-of-Pocket Costs (OOPC) for people with High-Cost Conditions (chronic care and unexpected illnesses)

1 An out-of-pocket cost maximum applies for some services covered by this plan.
2 Medicare costs at a glance
3 Estimated Annual Costs are rounded to the nearest $10. They don't include any Medicare Part D (prescription drug) late enrollment
penalty amounts that may apply to you. Also, if you have limited income and resources, your expenses may be lower.

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