Page 13 - Evaluation with Cover Letter for Henry Rose

Plans that appear to meet your criteria (cont'd)

Plan F, High-
Plan name Plan F Plan L Plan K
Deductible
Toll-Free Number NA NA NA NA

Estimated annual premiums for medical coverage
lity ratings from Medicare web site (best rating = 5 stars)
2017 standard Part B

premium of $134 a $1,608 $1,608 $1,608 $1,608
month*

Health plan annual
premiums (Medigap $1,800 $1,175 $550 $625
premiums are estimates)

Total $3,408 $2,783 $2,158 $2,233

Minimum costs for Medicare-covered services

Total medical premiums
(from above) $3,408 $2,783 $2,158 $2,233

Plan health deductible

(includes Part B deductible if $0 $183 $500 $183
not covered by plan**)

Annual Rx costs
(premiums, deductibles, co- $300 $300 $300 $300
pays)
Total Minimum Costs

(includes cost-sharing for the $3,708 $3,266 $2,958 $2,716
Rx drugs you now take)

Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays You will pay the full
You pay 10% of
No co-pays for
You pay 5% of
In-Network Specialist Medicare-covered Medicare-approved supplemental cost Medicare-approved
until this plan's
Co-Pays services amount deductible is amount
Out-of-Network satisfied.
Co-Pays
*This is 2017 Part B premium for new enrollees who are not yet receiving Social Security benefits. People who
have already started their Social Security benefits will pay $109 a month ($1,308 a year). Higher income people
may pay more. **Part B deductible is $183.

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