Page 11 - Cover Letter and Medicare evaluation for Mr. Rod Fallow
P. 11
Plans that appear to meet your criteria (cont'd)
UHC Medicare
Ava Advantage
Plan name Medigap Plan G Medigap Plan N Advantage Assure
HMO Plan
HMO Plan
Toll-Free Number NA NA (888) 979-2247 (800) 555-5757
Estimated medical premiums for 2022
lity ratings from Medicare web site (best rating = 5 stars)
2021 Standard Part B
premium* $1,782 $1,782 $1,782 $1,782
Health plan premiums
(Medigap premiums are $1,700 $1,450 $0 $0
estimates)
Total $3,482 $3,232 $1,782 $1,782
Minimum costs for Medicare-covered services
Total medical premiums $3,482 $3,232 $1,782 $1,782
(from above)
Plan health deductible
(includes Part B deductible $203 $203 $0 $0
if not covered by plan**)
Est. annual Rx costs at
CVS (premiums and co- $101 $101 $27 $376
pays)
Total Minimum Costs
(includes cost-sharing for $3,786 $3,536 $1,809 $2,158
the Rx drugs you now take)
Cost-sharing for doctors' office visits
=
In-Network Primary After Part B annual
Care Co-Pays No co-pays after deductible is paid, $35 20% co-insurance
In-Network Specialist the annual Part B up to $20 co-pays $35 20% co-insurance
Co-Pays deductible ($203) for doctors' office
Out-of-Network is paid visits and $50 for
ER visit
Co-Pays Not covered Not covered
*The 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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