Page 9 - Cover letter and evaluation for Paulina Rosenstein
P. 9
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
lity ratings frEomstiMmedaitcearde awnebnsuitael (pbersetmraituinmg =s 5fosrtamrs)edical coverage
2018 standard Part B
premium of $134 a $1,608 $1,608 $1,608 $1,608
month*
Health plan annual $3,700 $3,500 $2,775 $2,525
premiums (Medigap
premiums are estimates)
Total $5,308 $5,108 $4,383 $4,133
Minimum costs for Medicare-covered services
Total medical premiums $5,308 $5,108 $4,383 $4,133
(from above)
Plan health deductible $0 $183 $183 $183
NA NA NA NA
(includes Part B deductible if
not covered by plan**)
Annual Rx costs
(premiums, deductibles, co-
pays)
Total Minimum Costs $5,308 $5,291 $4,566 $4,316
(includes cost-sharing for the 5% of Medicare-
Rx drugs you now take) approved cost
Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays No co-pays for No co-pays for up to $20 for
In-Network Specialist Medicare-covered Medicare-covered Medicare-approved
doctor's visit; $50
Co-Pays services services
Out-of-Network for emergency
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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