Page 13 - Cover Letter and Medicare Evaluation for Andrea Masters
P. 13
Plans that appear to meet your criteria (cont'd)
CDPHP $0 Highmark Blue
Plan name Medigap Plan G Medigap Plan N Medicare Rx HMO Shield Freedom
Plan Nation PPO Plan
Toll-Free Number NA NA (888) 519-4455 (888) 875-2232
Estimated medical premiums for 2022
lity ratings from Medicare web site (best rating = 5 stars)
Standard Part B
$2,041 $2,041 $2,041 $2,041
premium *
Health plan premiums
(Medigap premiums are $2,400 $2,100 $0 $0
estimates)
Total $4,441 $4,141 $2,041 $2,041
Minimum costs for Medicare-covered services
Total medical premiums $4,441 $4,141 $2,041 $2,041
(from above)
Plan health deductible
(includes Part B deductible $233 $233 $0 $0
if not covered by plan**)
Annual Rx drug
premiums $86 $86 $0 $0
Total Minimum Costs
(includes cost-sharing for $4,760 $4,460 $2,041 $2,041
the Rx drugs you now take)
Cost-sharing for doctors' office visits
=
In-Network Primary After Part B annual
Care Co-Pays No co-pays after deductible is paid, $0 $0-$5 co-pay
In-Network Specialist the annual Part B up to $20 co-pays
Co-Pays deductible ($233) for doctors' office $0 - $40 $36 co-pay
Out-of-Network is paid visits and $50 for Not covered unless
ER visit
Co-Pays emergency 40% of cost
*The 2022 standard Part B premium for new enrollees is $170.10 a month; higher income people may pay
more. **Part B deductible in 2022 is $233.
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