Page 9 - Cover Letter and Evaluation for Janet Tuma

Your estimated costs in each plan

Aetna Medicare Value PPO Cigna Preferred Medicare Humana Gold Plus HMO
Plan Name
Plan HMO Plan Plan
Toll-Free Number (833) 859-6031 (888) 886-1993 (800) 833-2364

lity ratings from Your minimum annual costs
Medicare web site
2021 Part B premium

($148.50 a month)* $1,782 $1,782 $1,782

Health plan annual

premiums (Medigap $0 $0 $0
premiums are estimates)

Health plan deductible $0 $0 $0

2021 Rx drug costs (mail-
order) $17 $32 $0

Total $1,799 $1,814 $1,782

Part A and Part B out-of-pocket costs

Part A: Amounts owed $300 a day for days 1-7: $195 a day for days 1-7; $150 a day for days 1-7 in

for a hospitalization $0 for days 8-90; 50% of $0 for days 8 through 90. network hospital; $0
cost out of network.
thereafter.
Part B: Amounts owed It varies, but 20% co- Low co-pays for many
for most outpatient Varies in network, but up insurance for many services, 20% of cost for
to 50% out of network
services services others

Cost-sharing for doctors' office visits
=
In-Network Primary
Care Co-Pays $0 $0 $0

In-Network Specialist
Co-Pays $35 $20 $25
Out-of-Network $25 for primary care Not covered Not covered
Co-Pays doctor; $50 specialist.

*This is 2021 Part B premium for new enrollees. Higher income people may pay more.
**Part B deductible in 2021 is $203

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