Page 11 - Cover Letter and Medicare Evaluation for Eric Hartman

Plans that appear to meet your criteria (cont'd)

SCAN Venture
Advantage HMO Alignment Health
Plan Name Medigap Plan G Medigap Plan N PPO Advantage Plan
Plan (your current powered by Hoag
plan)

Toll-Free Number NA NA (800) 559-3500 (888) 979-2247

Estimated medical premiums for 2023
lity ratings from Medicare web site (best rating = 5 stars)
Standard Part B $659 after premium
$1,979 $1,979 $1,979
premium * rebate
Health plan premiums

(Medigap premiums are $2,800 $2,400 $0 $0
estimates)

Total $4,779 $4,379 $659 $1,979

Minimum costs for Medicare-covered services

Total medical premiums $4,779 $4,379 $659 $1,979
(from above)

Plan health deductible
(includes Part B deductible $226 $226 $0 $0
if not covered by plan**)

Est. annual Rx mail-
order costs (premiums $134 $134 $0 $0
and co-pays)

Total Minimum Costs
(includes cost-sharing for $5,139 $4,739 $659 $1,979
the Rx drugs you now take)

Cost-sharing for doctors' office visits

=
In-Network Primary After Part B annual
Care Co-Pays No co-pays after deductible is paid, $0 in network $0 in network
In-Network Specialist the annual Part B up to $20 co-pays

Co-Pays deductible ($226) for doctors' office $0 in network $20 in network
Out-of-Network is paid visits and $50 for $5 for PCP; $50 for
ER visit
Co-Pays Not covered specialist

*The 2023 standard Part B premium for new enrollees is $164.90 a month; higher income
people may pay more. **Part B deductible in 2023 is $226.

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