Page 14 - Cover Letter and Evaluation for Gary Caskey

Medigap Plan Comparisons: This chart shows how much cost- Core Benefits
sharing 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 A B
facility, and so on.

Estimated annual premiums for a 66-year-old man in DeKalb County $1,450 $1,875
Each plan's benefits relative to Plan F 70.7% 85.6%

Coverage Area 2018 Coverage Gap
$335 daily co-pay for days 61-90;
You pay
Part A Hospital Co-Insurance $670 daily co-pay for days 91-150; You pay
nothing
nothing
All plans cover 365 additional days.
Part A Skilled Nursing Facility Co- A $167.50 daily co-payment for days Not covered Not covered
Insurance 21-100 in a skilled nursing facility

Part A Hospice Care Co- 5% co-insurance for respite care; You pay
Insurance or Co-Payment $5 co-payment for inpatient drugs nothing You pay
nothing
Part A Hospital Deductible The $1,340 first-day deductible You pay $1,340

Part B Deductible In 2018 the Part B deductible is $183 You pay $183 You pay $183

20% of Medicare-approved amounts
Part B Co-Insurance or Co- for most services covered by Part B You pay You pay
Payment nothing nothing
after the $183 deductible is paid

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

The seven Medigap plans indicated do
Foreign Travel Emergencies** offer coverage for emergency medical Not covered Not covered
care in other countries.

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

**Estimated average annual premiums are based in most cases on your state insurance department's Medigap
premium comparisons or on quotes from an actuarial firm.

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

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