Page 11 - Cover Letter and Evaluation for Amy Prack

Your estimated costs in each plan

Humana Gold Plus AARP Medicare Humana Choice PPO
Medigap Plan G
Plan name HMO Plan Complete Plan 2 Plan
(at age 65)
(H6622-103) (HMO) (H5525-042)
Toll-Free Number NA (800) 833-2364 (800) 555-5757 (800) 833-2364

Health plan premiums + medical deductible + Rx drug costs
lity ratings from
Medicare web site
2019 Part B premium

($135.50 a month)* $1,626 $1,626 $1,626 $1,626

Health plan annual

premiums (Medigap $1,700 $0 $70 $0
premiums are estimates)
Health plan deductible $185 $0 $0 $0
(in network)

Annual Rx drug costs for
monthly refills at Giant $1,033 $640 $914 $843
Eagle Pharmacy

Total $4,544 $2,266 $2,610 $2,469
Part A and Part B out-of-pocket costs

Part A: The amount you
will pay if you are No cost $365 a day for days $325 a day for days $495 a day for days
1-4
1-3
1-4
hospitalized
Part B: Amounts owed No cost after $185 20% for some
for most outpatient Part B deductible Various co-pays Various co-pays services, various co-
services has been paid pays for others

Cost-sharing for doctors' office visits
=
In-Network Primary
Care Co-Pays $5 $5 $30
No co-pays for
In-Network Specialist Medicare-covered
Co-Pays doctors' office visits $45 $35 $50
Out-of-Network
Co-Pays Full cost Full cost Same as in-network

*This is 2019 Part B premium for new enrollees. Higher income people may pay more.
**Part B deductible in 2019 is $185.

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