Page 9 - Cover Letter and Evaluation for Mr. Michael Johnson

Your estimated costs in each plan

Plan name Medigap Plan F Medigap Plan G

Toll-Free Number NA NA

Minimum costs (health plan premiums + Rx drug costs)
lity ratings from
Medicare web site
2019 standard Part B
premium of $135.50 a $1,626 $1,626
month*

Health plan annual

premiums (Medigap $1,925 $1,700
premiums are estimates)
Rx drug costs (Rx
premiums + deductible + $656 $656

copayments)

Total $3,551 $3,326
Part A and Part B out-of-pocket costs

Part A: The amount you No cost for No cost for

will pay if you are Medicare-covered Medicare-covered
hospitalized hospitalization hospitalization

Part B: The amount you
will pay for most $ after Part B
Medicare-covered $0 deductible is paid
($185 in 2019)
outpatient services

Cost-sharing for doctors' office visits
=
In-Network Primary
Care Co-Pays No co-pays for
No co-pays for
Medicare-covered
In-Network Specialist Medicare-covered services after $185
Co-Pays services Part B deductible is
Out-of-Network paid
Co-Pays

*This is 2019 Part B premium for new enrollees. Higher income people may pay more.
**Part B deductible in 2019 is $185.

3