Page 11 - Cover Letter and Medicare Evaluation for Donald Pender
P. 11
Plans that appear to meet your criteria (cont'd)
Platinum Blue Shield 65 Plus
Plan name Medigap Plan G Medigap Plan N Advantage HMO Advantage HMO
Plan Plan
Toll-Free Number NA NA (888) 979-2247 (888) 534-4263
Estimated medical premiums
lity ratings from Medicare web site (best rating = 5 stars)
2021 Standard Part B
$1,782 $1,782 $1,782 $1,782
premium *
Health plan premiums
(Medigap premiums are $1,850 $1,650 $0 $0
estimates)
Total $3,632 $3,432 $1,782 $1,782
Minimum costs for Medicare-covered services
Total medical premiums $3,632 $3,432 $1,782 $1,782
(from above)
Plan health deductible
(includes Part B deductible $203 $203 $0 $0
if not covered by plan**)
Annual Rx drug plan
$399 $399 $0 $30
costs (mail order)
Total Minimum Costs
(includes cost-sharing for $4,234 $4,034 $1,782 $1,812
the Rx drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary After Part B
Care Co-Pays deductible ($203) $0 $0
No co-pays after
In-Network Specialist the annual Part B is paid, up to $20
co-payments for
Co-Pays deductible ($203) doctors' office $0 $0
is paid
Out-of-Network visits and $50 for
Co-Pays ER visit. Not covered Not covered
*This is 2021 standard Part B premium for new enrollees is $148.50 a month; higher
income people may pay more. **Part B deductible in 2021 is $203.
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