Page 13 - Cover Letter and Evaluation for Susan Marx

Various estimated costs in each plan

Aetna Medicare UPMC for Life HMO
Plan name Medigap Plan G Medigap Plan N
Value PPO Plan Premier Rx Plan
NA NA (855) 275-6627 (877) 381-3765

Health plan premiums + medical deductible + Rx drug costs
lity ratings from
Medicare web site
2020 Part B premiums
for 8 months ($144.60 a $1,157 $1,157 $1,157 $1,157
month)*

Health plan premiums
for 8 months $1,000 $800 $0 $0

Health plan/Part B
deductible** $198 $198 $1,000 $0

2020 Rx drug costs for

8 months, mail-order $4,538 $4,538 $4,483 $4,401

Total $6,893 $6,693 $6,640 $5,558

Part A and Part B out-of-pocket costs

Part A: The amount you $185 a day for days $150 a day for days
1-6 in a network
will pay if you are No cost No cost hospital; $0 for days 1-5 in a network
hospital; $0 for
hospitalized 7-90 days 6-90

Part B: Amounts owed After Part B Below are cost- Small co-pays for Varies. No coverage
most network
for most outpatient deductible is paid, sharing amounts services; 40-45% out of network
no cost for
after Part B
services Medicare services deductible is paid out of network unless emergency
Cost-sharing for doctors' office visits
=
In-Network Primary After $198 Part B
Care Co-Pays deductible is paid, $10 $0
After $198 Part B
In-Network Specialist deductible is paid, up to $20 for
Co-Pays no cost doctors' office visits $35 $40
Out-of-Network and $50 for visit to
emergency room
Co-Pays 40% of cost No coverage

*The 2020 standard Part B premium for new enrollees is $144.60. Higher income people may pay more.
**Part B deductible in 2020 is $198.

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