Page 17 - Cover letter and evaluation for Thomas Barr

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

Johns Hopkins
Plan name Medigap Plan F Medigap Plan N Medigap Plan L Advantage MD PPO
Plan
Toll-Free Number NA NA NA 888-403-7682

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 premiums $2,500 $1,650 $1,600 $68
are estimates)

Total $4,108 $3,258 $3,208 $1,676

Minimum costs for Medicare-covered services

Total medical premiums $4,108 $3,258 $3,208 $1,676
(from above)

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

Annual Rx costs (premiums, $163 $163 $163 $512
deductibles, co-pays)

Total Minimum Costs
(includes cost-sharing for the Rx $4,271 $3,604 $3,554 $2,188
drugs you now take)

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

Care Co-Pays up to $20 for $10
No co-pays for Medicare-approved
In-Network Specialist Medicare-covered doctor's visit; $50 5% of Medicare-
Co-Pays services for emergency approved cost $50
Out-of-Network room visit

Co-Pays 30% of cost
*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 in 2017 is $183.

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