Page 12 - Evaluation with Cover Letter for Henry Rose

Plans that appear to meet your criteria

These four plans are compared on this page and the following page.

Plan F, High-
Plan Name Plan F Plan L Plan K
Deductible

Toll-Free Number NA NA NA NA
QuaSection Heading How do these plans compare?
lity ratings from

Can you continue to see
your physician(s)? Yes Yes Yes Yes

How large is the plan's You can see any You can see any You can see any You can see any
provider who
provider who
provider who
provider who
provider network? accepts Medicare accepts Medicare accepts Medicare accepts Medicare
Do you need referrals to
see specialists? No No No No

25% of the Part A
What is the potential cost No cost for deductible of $1,316 if the
of a hospital stay? Medicare-covered $1,316 (you pay deductible has not $658
hospital services been met
$329)

Excellent. It does Very good. $2,560 Excellent. It does
How good is the plan's not have an out-of- out-of-pocket limit not have an out-of- Average. $5,120
catastrophic coverage? pocket limit, for services the pocket limit, out-of-pocket limit
+ Part B deductible
though plan covers though

What are Medicare's Medigap policies Medigap policies Medigap policies Medigap policies
ratings for this plan? are not rated by are not rated by are not rated by are not rated by
Medicare Medicare Medicare Medicare

Benefits for services not covered by Medicare

Routine dental care Not covered Not covered Not covered Not covered

Routine vision care Not covered Not covered Not covered Not covered

After $250 The same as
deductible, 80% of standard Plan F
Foreign travel emergencies Not covered Not covered
costs ($50,000 once the
lifetime limit) deductible is met

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