Page 11 - Cover letter and evaluation for Michele Buros

Plans that appear to meet your criteria (cont'd)

Community Blue
Plan name Medicare PPO Advantra Silver PPO Humana Value Plus Aetna Medicare Gold
PPO Plan
PPO Plan
Plan
Signature Plan
Toll-Free Number (844) 785-1787 (855) 338-9566 (800) 833-2364 (855) 338-7027
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 $1.20 $168 $0 $1,571
premiums are estimates)

Total $1,609 $1,776 $1,608 $3,179

Minimum costs for Medicare-covered services

Total medical premiums
(from above) $1,609 $1,776 $1,608 $3,179

Plan health deductible

(includes Part B deductible if Yes $183 $500
not covered by plan**)

Annual Rx costs, monthly

refills at Giant Eagle $155 $264 $329 $349

Total Minimum Costs

(includes cost-sharing for the $1,764 $2,040 $2,120 $4,028
Rx drugs you now take)

Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays $0 $5 $5

In-Network Specialist 20% of cost per visit
in-and-out of
Co-Pays $40 $35 network $25
Out-of-Network
$25 primary care;
Co-Pays $60 specialist 40% of cost 20% of cost

*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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