Page 51 - Cover Letter and Evaluation for Amy Prack
P. 51
Costs
Monthly Premiums
Part B premium 2 $135.50
View Part B premiums based on income
Plan premium $0.00
Health plan premium $0.00
Drug plan premium $0.00
Estimated Costs
*Inpatient care $25.00
*Outpatient prescription drugs $53.31
*Dental services $42.00
*All other services
$73.00
Total monthly estimated costs
$328.81
TOTAL ESTIMATED ANNUAL COSTS 3 [?] $3,950
How are Out-of-Pocket costs calculated?
View estimated monthly Out-of-Pocket Costs (OOPC) for people with High-Cost Conditions (chronic care and unexpected illnesses)
1 An out-of-pocket cost maximum applies for some services covered by this plan.
2 Medicare costs at a glance
3 Estimated Annual Costs are rounded to the nearest $10. They don't include any Medicare Part D (prescription drug) late enrollment
penalty amounts that may apply to you. Also, if you have limited income and resources, your expenses may be lower.
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