Page 14 - Cover Letter and Medicare Evaluation for Eric Hartman

Medigap Plan Comparisons: This chart shows how much cost- Core Benefits
sharing you will have in each Medigap plan. Not included are
payments for services that Medicare does not cover like routine
dental/vision care, hearing aids, benefits for more than 100 days a A B
skilled nursing facility, and so on.
Est. Medigap premiums for a 78-year-old man in Orange County, CA $1,800 $2,500

Each plan's benefits relative to 100% coverage of all Medicare gaps 70.7% 85.6%
Coverage Area 2023 Coverage Gap
$400 daily co-pay for days 61-90;
Part A Hospital Co-Insurance $800 daily co-pay for days 91-150; All plans You pay You pay
nothing
nothing
cover 365 additional days.
Part A Skilled Nursing Facility Co- A $200 daily co-payment for days 21-100 in
Insurance a skilled nursing facility Not covered Not covered

Part A Hospice Care Co- 5% co-insurance for respite care;
Insurance You pay
or Co-Payment $5 co-payment for inpatient drugs nothing You pay
nothing
You pay
Part A Hospital Deductible In 2023 the Part A deductible is $1,600
$1,600

Part B Deductible In 2023 the Part B deductible is $226 You pay $226 You pay $226

20% of Medicare-approved amounts for
Part B Co-Insurance or Co- most services covered by Part B after the You pay You pay
Payment nothing nothing
$226 deductible is paid

In most states, providers who do not
Part B Excess Charges accept assignment can charge up to 15% Not covered Not covered
more than Medicare-approved amounts.

Medicare does not cover medical care
outside the United States. But the seven
Foreign Travel Emergencies** Medigap plans indicated do offer some Not covered Not covered
coverage for emergency medical care in
other countries.

You pay You pay
Blood First 3 pints of blood
nothing nothing
*Estimated annual premiums are based in most cases on your state insurance department's Medigap premium
comparisons or on quotes from an actuarial firm. There can be large variations in premiums from one company
to another, and it's a good idea to get several current quotes.

**Plans C, D, F, G, M, and N include benefits for foreign travel emergencies. They cover 80% of cost of medical
emergencies while traveling in other countries, with a $250 deductible and a $50,000 lifetime limit.

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