Page 11 - Cover Letter and Medicare Evaluation for Barbara Pender
P. 11

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



                                                                           SCAN Classic    Blue Shield Inspire
                        Plan name    Medigap Plan G    Medigap Plan N    Advantage HMO      Advantage HMO
                                                                               Plan              Plan

                Toll-Free Number           NA                NA           (888) 315-7226    (888) 534-4263

                                        Estimated medical premiums
          lity ratings from Medicare web site (best rating = 5 stars)
            2021 Standard Part B
                                         $1,782            $1,782             $1,782            $1,782
                        premium *
            Health plan premiums
               (Medigap premiums are     $1,750            $1,600               $0                $0
                         estimates)

                             Total       $3,532            $3,382             $1,782            $1,782

                            Minimum costs for Medicare-covered services

          Total medical premiums         $3,532            $3,382             $1,782            $1,782

                       (from above)

           Plan health deductible
            (includes Part B deductible   $203              $203                $0                $0
             if not covered by plan**)


              Annual Rx drug plan
                        premiums           $90               $90                $0                $0



            Total Minimum Costs
             (includes cost-sharing for   $3,825           $3,675             $1,782            $1,782
            the Rx drugs you now take)

                                  Cost-sharing for doctors office visits
                                                                     =
            In-Network Primary                           After Part B

               Care Co-Pays                            deductible ($203)        $0                $0
                                     No co-pays after
          In-Network Specialist     the annual Part B   is paid, up to $20
                                                       co-payments for
                  Co-Pays           deductible ($203)   doctors' office         $0                $0
                                         is paid
             Out-of-Network                            visits and $50 for
                  Co-Pays                                  ER visit.       Not covered        Not covered

          *This is 2021 standard Part B premium for new enrollees is $148.50 a month; higher
          income people may pay more.                    **Part B deductible in 2021 is $203.


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