Page 13 - Cover letter and evaluation for Darlene Hoover
P. 13
Plans that appear to meet your criteria (cont'd)
Aetna Medicare Anthem MediBlue
Plan name Medigap Plan N Medigap Plan L
Value PPO Plan Plus HMO Plan
Toll-Free Number NA NA (833) 859-6031 (844) 373-7113
Estimated annual premiums for medical coverage
lity ratings from Medicare web site (best rating = 5 stars)
2019 standard Part B
premium of $135.50 a $1,626 $1,626 $1,626 $1,626
month*
Health plan annual
premiums (Medigap $1,125 $1,050 $0 $0
premiums are estimates)
Total $2,751 $2,676 $1,626 $1,626
Minimum costs for Medicare-covered services
Total medical premiums $2,751 $2,676 $1,626 $1,626
(from above)
Plan health deductible
(includes Part B deductible if $185 $185 $0 $0
not covered by plan**)
Annual Rx costs with
monthly refills at CVS $186 $186 $0 $0
Total Minimum Costs
(includes cost-sharing for the $3,122 $3,047 $1,626 $1,626
Rx drug you now take)
Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays Up to $20 for $0 $5
You pay 5% of
In-Network Specialist doctor's office visit; Medicare approved
Co-Pays $50 for emergency amount $35 $40
Out-of-Network room visit
Co-Pays $20 and $55 Not covered
*This is 2019 standard Part B premium for new enrollees who are not yet receiving Social Security benefits.
**Part B deductible in 2019 is $185.
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