Page 13 - Cover Letter and Evaluation for Dr. Jim Fisgus

Your estimated costs in each plan

Aetna PPO Plan for
Aetna Medicare
Plan name Gensler Choice PPO Plan Medigap Plan G Medigap Plan N
(Current Plan)
Toll-Free Number NA (855) 275-6627 NA NA

Health plan premiums + medical deductible + Rx drug costs
lity ratings from
Medicare web site
2019 Part B premium

($135.50 a month)* NA $1,626 $1,626 $1,626

Health plan annual

premiums (Medigap $2,631 $497 $2,150 $1,800
premiums are estimates)
Health plan
deductible*** $600 $750 $185 $185

Rx drug costs (premiums, $240 $475 $198 $198
deductible, co-pays)

Total $3,471 $3,348 $4,159 $3,809
Part A and Part B out-of-pocket costs

Part A: The amount you 20% after $500 co- $225 a day for days No cost for No cost for
will pay if you are pay in a network 1-5 in a network Medicare-covered Medicare-covered
hospitalized hospital hospital hospitalization hospitalization

Part B: Amounts owed Varies. 20% for Varies. 20% co- No cost after $185 Doctors' office/ER
for most outpatient most network insurance for many Part B deductible is costs (see below)
and Part B
services services network services met deductible ($185)

Cost-sharing for doctors' office visits
=
In-Network Primary
Care Co-Pays 20% $10 up to $20 for
No co-pays for Medicare-approved
In-Network Specialist Medicare-covered doctor's office visit;
Co-Pays 20% $40 doctors' office visits $50 for emergency
Out-of-Network room visit
Co-Pays 40% of cost 40% of cost

*This is 2019 Part B premium for new enrollees. Higher income people may pay more.
**Part B deductible in 2019 is $185. ***The Gensler plan has a separate $1,500 out-of-network deductible

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