Page 15 - Cover Letter and Medicare evaluation for Dr. Peter Yesawich

Your estimated costs in each plan

Bright Advantage Aetna Medicare
Plan name Medigap Plan F Medigap Plan N Part B Savings PPO Premier Plus PPO
Plan Plan
Toll-Free Number NA NA (844) 679-2028 (855) 275-6627

Health plan premiums + medical deductible + Rx drug costs
lity ratings from
Medicare web site
2021 Part B premium
($148.50 a month)* $1,782 $1,782 $822 $1,782

Health plan annual

premiums (Medigap $3,300 $2,500 $0 $0
premiums are estimates)
Plan medical/Part B NA $203 $0 $0
deductible**

2021 Rx drug costs for
retail pharmacy refills $2,761 $2,761 $438 $1,483

Total $7,843 $7,246 $1,260 $3,265
Part A and Part B out-of-pocket costs
$

Part A: The amount you $240 a day for days $250 a day for days
will pay if you are No cost No cost 1-7 in a network 1-4 in a network
hospital; $0
hospital; $0 for
hospitalized thereafter days 5-90

Part B: Amounts owed Shown below are Small co-pays in Small co-pays in
network; 50% of
for most outpatient No cost cost-sharing amonts network; 40% of cost for many out-
after Part B
cost for many out-
services deductible is met of-network services of-network services

Cost-sharing for doctors' office visits
=
In-Network Primary

Care Co-Pays $20 for doctor's $0 $0
In-Network Specialist No cost office visits and $50
Co-Pays for emergency $30 $35
Out-of-Network room visits $0 primary care; $55 primary care;
Co-Pays $50 specialist $65 specialist
*This is 2021 Part B premium for new enrollees. Higher income people may pay more. Bright Advantage plan has
$80 a month Part B premium rebate
**Part B deductible in 2021 is $203; medical deductibles for Advantage plans vary.

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