Page 67 - Cover letter and evaluation for Thomas Barr
P. 67
10/14/2017 Your Medicare Health Plan Details
View Drug Benefit Summary
Provider Network: 9001-10000 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 2018
Costs
Monthly Premiums
2
Part B premium $134.00
View Part B premiums based on income
Plan premium $47.00
Health plan premium $5.70
Drug plan premium $41.30
Estimated Costs
*Inpatient care $31.00
*Outpatient prescription drugs $1.38
*Dental services $32.00
*All other services
$120.00
Total monthly estimated costs
$365.38
3
TOTAL ESTIMATED ANNUAL COSTS [?] $4,380
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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