Page 11 - Cover letter and evaluation for Marcelle Nesci

Your estimated costs in each plan

UnitedHealthcare
Plan name Medigap Plan F Medigap Plan G Medigap Plan N MedicareComplete
Choice Plan 1
Toll-Free Number NA NA NA (800) 555-5757

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 $1,626 $1,626
month*

Health plan annual

premiums (Medigap $3,000 $2,800 $2,200 $0
premiums are estimates)
Rx drug costs, mail
order (Rx premiums + $761 $761 $761 $624

copayments)

Total $4,626 $4,426 $3,826 $1,626
Part A and Part B out-of-pocket costs

Part A: The amount you No cost for No cost for No cost for $395 a day for days
1-4 in network
will pay if you are Medicare-covered Medicare-covered Medicare-covered hospital; nothing
hospitalized hospitalization hospitalization hospitalization thereafter

Part B: The amount you See below for cost-
will pay for most $185 a year (Part B sharing amounts Various co-pays for
Medicare-covered $0 deductible) after $185 Part B covered services
outpatient services deductible is paid

Cost-sharing for doctors' office visits
=
In-Network Primary
Care Co-Pays No co-pays for up to $20 for $10
Medicare-covered Medicare-approved
No co-pays for
In-Network Specialist Medicare-covered services after $185 doctor's office visit;
Co-Pays services Part B deductible is $50 for emergency $45
Out-of-Network paid room visit
Co-Pays $50 and $75

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

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