Page 12 - Cover letter and evaluation for Paulina Rosenstein

Medigap Plan Comparisons: This chart shows how much cost-sharing you Core Benefits
AB
will have in each Medigap plan. Not included are payments for services that
Medicare does not cover like routine dental/vision care, hearing aids, benefits for
more than 100 days a skilled nursing facility, and so on.

Coverage Area Each plan's benefits relative to Plan F $2,425 $3,150
2018 Coverage Gap 70.7% 85.6%

$335 daily co-pay for days 61-90; You pay You pay
Part A Hospital Co-Insurance $670 daily co-pay for days 91-150; nothing nothing

All plans cover 365 additional days. Not covered

Part A Skilled Nursing Facility Co- A $167.50 daily co-payment for days 21-100 in a Not covered
Insurance skilled nursing facility

Part A Hospice Care Co-Insurance 5% co-insurance for respite care; You pay You pay
or Co-Payment $5 co-payment for inpatient drugs nothing nothing

Part A Hospital Deductible The $1,340 first-day deductible You pay $1,340

Part B Deductible In 2018 the Part B deductible is $183 You pay $183 You pay $183

Part B Co-Insurance or Co- 20% of Medicare-approved amounts for most You pay You pay
Payment services covered by Part B after the $183 nothing nothing
deductible is paid

In most states, providers who do not accept

Part B Excess Charges assignment can charge up to 15% more than Not covered Not covered
Medicare-approved amounts. Three Medigap

plans cover these excess charges.

Medicare does not cover medical care outside

Foreign Travel Emergencies** the United States. But the seven Medigap plans Not covered Not covered
indicated do offer some coverage for emergency

medical care in other countries.

Blood First 3 pints of blood You pay You pay
nothing nothing

**Estimated average annual premiums are based in most cases on your state insurance department's Medigap premium
comparisons or on quotes from an actuarial firm. There can be large variations in premiums from one company to another, and
it's a good idea to get several current quotes.

**Plans C, D, F, G, M, and N include benefits for foreign travel emergencies. These plans cover 80% of cost of medical
emergencies while traveling in other countries. This coverage has a $250 deductible and a $50,000 lifetime limit.

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