Page 11 - Cover Letter and Evaluation for Susan Church

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

Humana Gold Plus Humana Choice Humana Choice
Plan name HMO Plan (H4141- PPO Plan (H5216- PPO Plan (H5216- Medigap Plan N
015) 147) 153)

Toll-Free Number (800) 833-2364 (800) 833-2364 (800) 833-2364 NA
Client preference:
Estimated annual premiums for medical coverage
monthly refills at a
CVS Pharmacy
2019 standard Part B
premium of $135.50 a $1,626 $1,626 $1,026*** $1,626

month

Health plan annual
premiums (Medigap $0 $0 $0 $1,250
premiums are estimates)

Total $1,626 $1,626 $1,026 $2,876

Minimum costs for Medicare-covered services

Total medical premiums $1,626 $1,626 $1,026 $2,876
(from above)

Plan health deductible
(includes Part B deductible if $0 $0 $1,000 $185
not covered by the plan)
Rx costs, monthly refills

at CVS (premiums, $903 $984 $1,020 $773
deductibles, co-pays)

Total Minimum Costs
(includes cost-sharing for the $2,529 $2,610 $3,046 $3,834
Rx drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary

Care Co-Pays $0 $5 $20 You pay up to $20
for doctors' office
In-Network Specialist visits and $50 for an
Co-Pays $10 - $40 $45 $50 emergency room
Out-of-Network visit
Not covered unless
Co-Pays emergency 25% of cost 40% of cost
*This is 2019 standard Part B premium. **Part B deductible in 2019 is $185.
***This plan has a $50 a month rebate of the Part B premium

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