Page 9 - Cover letter and Medicare evaluation for Hans Burkhardt
P. 9
Plans that appear to meet your criteria (cont'd)
Plan name Medigap Plan G Medigap Plan N Advantage plans are not compared in
this evaluation
Toll-Free Number NA NA
Estimated medical premiums for last 3 months of 2021
lity ratings from Medicare web site (best rating = 5 stars)
2021 Standard Part B
$446 $446
premium *
Health plan premiums
(Medigap premiums are $425 $325
estimates)
Total $871 $771
Minimum costs for Medicare-covered services
Total medical premiums $871 $771
(from above)
Plan health deductible
(includes Part B deductible $203 $203
if not covered by plan**)
Three-month Rx costs
$21 $21
at CVS (premiums only)
Total Minimum Costs
(includes cost-sharing for $1,095 $995
the Rx drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary After Part B
Care Co-Pays No co-pays after deductible ($203)
In-Network Specialist the annual Part B is paid, up to $20
co-payments for
Co-Pays deductible ($203) doctors' office
Out-of-Network is paid visits and $50 for
Co-Pays ER visit.
*The 2021 standard Part B premium is $148.50 a month; higher income people may pay more.
**Part B deductible in 2021 is $203.
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