Page 15 - Cover Letter and Evaluation for Gary Caskey

Comprehensive Benefits Comprehensive Benefits with Higher Cost-Sharing

F
C D F G (High K L M N
Deductible)

$2,180 $2,000 $2,200 $2,000 $1,000 $1,200 $1,400 $1,950 $1,650

99.7% 97.1% 100.0% 97.3% 43.5% 53.5% 72.6% 84.2% 71.5%
Co-Payments and Cost-Sharing

You pay You pay
nothing nothing

You pay You pay You pay

You pay You pay $83.75 a $41.88 a nothing You pay
nothing nothing After you day day nothing
have paid You pay You pay

You pay the plan's 2.5% & 1.25% &
nothing $2,240 $2.50 $1.25
deductible, You pay You pay You pay
You pay you will $670 $335 $670
nothing have no
You pay You pay further cost- You pay You pay You pay
$183 $183 $183 $183 $183 You pay $183
sharing for
Medicare- You pay 10% You pay 5% Only costs are
You pay covered of Medicare- of Medicare- You pay $20 for doctor's
nothing services. approved approved nothing office visits; $50
amount amount for an ER visit
You pay
nothing

Not Not
Not covered Not covered Not covered Not covered
covered covered

Some Some Some Some Some Not Not Some Some
coverage* coverage* coverage* coverage* coverage* covered covered coverage* coverage*

You pay You pay You pay You pay You pay You pay You pay 5% You pay You pay
nothing nothing nothing nothing nothing 10% of cost of cost nothing nothing

2018 high-deductible amount = $2,240

2018 Out-of-Pocket Limit*** $5,240 $2,620

*** Out-of-pocket limits do not include plan premiums. Neither do they apply to services that are not covered. In Plans K and L, for
instance, the Part B deductible is not covered. Thus any money you spend for the deductible will not count toward the OOP limit.

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