Page 13 - Cover Letter and Evaluation for Steve DIckhaus

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

HealthPartners
Minnesota Basic Minnesota
Plan name Medigap Plan N Journey Pace PPO
Plan Extended Basic Plan
Plan
Toll-Free Number NA NA NA (844) 363-8979

Estimated annual premiums for medical coverage
lity ratings from Medicare web site (best rating = 5 stars)
2020 standard Part B

premium of $144.60 a $1,735 $1,735 $1,735 $1,735
month*

Health plan annual
premiums (Medigap $1,800 $2,450 $1,900 $0
premiums are estimates)

Total $3,535 $4,185 $3,635 $1,735

Minimum costs for Medicare-covered services

Total medical premiums $3,535 $4,185 $3,635 $1,735
(from above)

Plan health deductible

(includes Part B deductible if $198 $198 $198 $0
not covered by plan**)
Annual Rx costs
(premiums and co-pays). The $166 $166 $166 $79
$166 annual cost is for
Walmart Pharmacy.
Total Minimum Costs
(includes cost-sharing for the $3,899 $4,549 $3,999 $1,814
Rx drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary

Care Co-Pays No co-payments for No co-payments for $25
Medicare-covered Medicare-covered You pay up to $20
In-Network Specialist doctors office visits doctors office visits for doctors' office
Co-Pays after Part B after Part B visits $50

Out-of-Network ductible is paid deductible is paid 40% of cost
de
Co-Pays

*This is standard 2020 Part B premium. Higher income people may pay more. **Part B deductible is $198.

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