Page 66 - Cover letter and evaluation for Peter Smith

11/27/2017 Your Medicare Health Plan Details
Plan Type: Local Preferred Provider Organization
Plan Status: Approved by Medicare
Area: Clark County

View plan website 
Important Note:
This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.
This plan's deductible only applies to out-of-network services.

View Drug Benefit Summary

Provider Network: 2501-3000 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 $46.00

Health plan premium $0.00

Drug plan premium $46.00
Estimated Costs

*Inpatient care $32.00

*Outpatient prescription drugs $336.14

*Dental services $33.00

*All other services
$81.00
Total monthly estimated costs
$662.14

3
TOTAL ESTIMATED ANNUAL COSTS [?] $7,950
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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