Page 12 - Cover letter and Medicare evaluation for Hans Burkhardt

Medigap Plan Comparisons: This chart shows how much cost-sharing Core Benefits
you will have in each Medigap plan. Not included are payments for
services that Medicare does not cover like routine dental/vision care,
hearing aids, benefits for more than 100 days a skilled nursing facility, A B
and so on.
Est. annual premiums for a 66-year-old man in Alameda County, CA $1,125 $1,400

Each plan's benefits relative to 100% coverage of Medicare's gaps 70.7% 85.6%
Coverage Area 2021 Coverage Gap
$371 daily co-pay for days 61-90;
Part A Hospital Co- $742 daily co-pay for days 91-150; All plans cover You pay You pay
Insurance nothing nothing
365 additional days.

Part A Skilled Nursing A $185.50 daily co-payment for days 21-100 in a Not covered Not covered
Facility Co-Payment skilled nursing facility
Part A Hospice Care Co- Hospice care is 100% covered; you pay 5% co- You pay
Insurance insurance for respite care and up to nothing
and Co-Payments $5 co-payment for inpatient drugs You pay
nothing
You pay
Part A Hospital Deductible In 2021 the Part A deductible is $1,484
$1,484

Part B Deductible In 2021 the Part B deductible is $203 You pay $203 You pay $203

20% of Medicare-approved amounts for most
Part B Co-Insurance or Co- You pay You pay
Payment services covered by Part B after the $203 nothing nothing
deductible is paid

In most states, providers who do not accept
assignment can charge up to 15% more than
Part B Excess Charges Not covered Not covered
Medicare-approved amounts. Three Medigap plans
cover these excess charges.

Medicare does not cover medical care outside the
Foreign Travel United States. But the seven Medigap plans
Emergencies** indicated do offer some coverage for emergency Not covered Not covered
medical care in other countries.

You pay You pay
Blood First 3 pints of blood nothing nothing

*Estimated annual premiums are based in most cases on your state insurance department's Medigap premium
comparisons or on quotes from an actuarial firm. There can be large variations in premiums from one company
to another, and it's a good idea to get several current quotes.

**Plans D, G, M, and N include benefits for foreign travel emergencies. They cover 80% of cost of medical
emergencies while traveling in other countries. This coverage has a $250 deductible and $50,000 lifetime limit.

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