Page 13 - Cover Letter and Evaluation for LuAnn Vander Vorste
P. 13
Plans that appear to meet your criteria (cont'd)
Plan name Medigap Plan F Medigap Plan G Medigap Plan N Medigap Plan L
Toll-Free Number NA NA NA NA
Estimated annual premiums for medical coverage
lity ratings from Medicare web site (best rating = 5 stars)
2018 standard Part B
premium of $134 a $1,608 $1,608 $1,608 $1,608
month*
Health plan annual
premiums (Medigap $2,100 $1,900 $1,575 $1,450
premiums are estimates)
Total $3,708 $3,508 $3,183 $3,058
Minimum costs for Medicare-covered services
Total medical premiums $3,708 $3,508 $3,183 $3,058
(from above)
Plan health deductible
(includes Part B deductible if $0 $183 $183 $183
not covered by plan**)
Annual Rx costs
w/monthly refills at a $257 $257 $257 $257
CVS Pharmacy
Total Minimum Costs
(includes cost-sharing for the $3,965 $3,948 $3,623 $3,498
Rx drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays up to $20 for
No co-pays for No co-pays for Medicare-approved
In-Network Specialist Medicare-covered Medicare-covered doctor's visit; $50 5% of Medicare-
Co-Pays services services for emergency approved cost
Out-of-Network room visit
Co-Pays
*This is 2018 Part B premium for new enrollees. Higher income people may pay more.
**Part B deductible in 2018 is $183.
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