Page 170 - Cover Letter and Evaluation for Sue Marx

2/7/2019 Your Medicare Health Plan Details

Provider Network: 20001 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 2019.

Costs

Monthly Premiums

2
Part B premium $135.50
View Part B premiums based on income
Plan premium $47.00

Health plan premium $7.70

Drug plan premium $39.30
Estimated Costs

*Inpatient care $7.00

*Outpatient prescription drugs $436.82

*Dental services $27.00

*All other services
$76.00
Total monthly estimated costs
$729.32

3
TOTAL ESTIMATED ANNUAL COSTS [?] $8,750

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.

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