Page 13 - Cover Letter & Evaluation for David Steenburgen
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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 $2,450 $2,250 $1,850 $1,675
premiums are estimates)
Total $4,058 $3,858 $3,458 $3,283
Minimum costs for Medicare-covered services
Total medical premiums
(from above) $4,058 $3,858 $3,458 $3,283
Plan health deductible
(includes Part B deductible if $0 $183 $183 $183
not covered by plan**)
Annual Rx costs
(premiums, deductibles, co- $152 $152 $152 $152
pays)
Total Minimum Costs
(includes cost-sharing for the $4,210 $4,193 $3,793 $3,618
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
In-Network Specialist Medicare-covered Medicare-covered Medicare-approved 5% of Medicare-
doctor's visit; $50
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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