Page 11 - Cover letter and evaluation for Lee Palmiter

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

Medigap High-
Plan name Medigap Plan F Medigap Plan G Medigap Plan N
Deductible Plan F

Toll-Free Number NA NA NA NA

Estimated annual premiums for medical coverage
lity ratings from Medicare web site (best rating = 5 stars)
2019 standard Part B
premium of $135.50 a $1,626 $1,626 $1,626 $1,626

month*

Health plan annual
premiums (Medigap $2,300 $2,100 $1,600 $900
premiums are estimates)

Total $3,926 $3,726 $3,226 $2,526

Plan premiums + health deductible + costs for your Rx drugs

Total medical premiums $3,926 $3,726 $3,226 $2,526
(from above)

Plan health deductible
(includes Part B deductible if $0 $185 $185 $2,300
not covered by plan**)
Annual Rx drug costs
(premiums + deductible + $1,910 $1,910 $1,910 $1,910

co-pays)

Total (includes cost-sharing $5,836 $5,821 $5,321 $6,736
for the Rx drugs you now take)

Cost-sharing for doctors office visits
=
In-Network Primary No co-pays for No co-pays for

Care Co-Pays Medicare-covered Medicare-covered
No co-pays for
In-Network Specialist Medicare-covered services after Up to $20 per visit services after
Co-Pays services you've paid the you've paid the
Out-of-Network $185 Part B plan's $2,300
deductible
deductible
Co-Pays
*This is 2019 standard Part B premium for new enrollees who are not yet receiving Social Security benefits.
**Part B deductible in 2019 is $185.

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