Page 55 - Cover Letter and Evaluation for Bob Workman
P. 55
10/25/2017 Your Medicare Health Plan Details
Provider Network: 20000 and above physicians and providers.
View provider and physician network website
View a chart on how an independent sales agent or broker would be compensated if they were to enroll you in a plan
for 2018
Costs
Monthly Premiums
2
Part B premium $134.00
View Part B premiums based on income
Plan premium $0.00
Health plan premium $0.00
Drug plan premium Not Applicable
Estimated Costs
*Inpatient care $24.00
*Outpatient prescription drugs $301.97
*Dental services $28.00
*All other services
$71.00
Total monthly estimated costs
$558.97
3
TOTAL ESTIMATED ANNUAL COSTS [?] $6,710
How are Out-of-Pocket costs calculated?
View estimated monthly Out-of-Pocket Costs (OOPC) for people with High-Cost Conditions (chronic care and
unexpected illnesses)
1 An out-of-pocket cost maximum applies for some services covered by this plan.
2 Medicare costs at a glance
3 Estimated Annual Costs are rounded to the nearest $10. They don't include any Medicare Part D (prescription drug) late enrollment
penalty amounts that may apply to you. Also, if you have limited income and resources, your expenses may be lower.
A federal government website managed and paid for by the U.S. Centers for
Medicare &
Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244
https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=H5216&plnid=046&sgmntid=0 2/2
