Page 15 - Cover Letter and Evaluation for Patricia Stelter -- PDF version

Your estimated costs in each plan

AARP Medicare
Aetna Medicare
Plan name Medigap Plan G Medigap Plan N Advantage
Value PPO
Walgreens PPO
Toll-Free Number NA NA (855) 275-6627 (800) 555-5757

Health plan premiums + medical deductible + Rx drug costs
lity ratings from
Medicare web site
2020 Part B premium

($144.60 a month)* $1,735 $1,735 $1,735 $1,735

Health plan annual

premiums (Medigap $1,600 $1,200 $0 $0
premiums are estimates)
Plan or Part B
deductible** $198 $198 $0 $0

2021 Rx drug costs at a
preferred pharmacy $2,010 $2,010 $1,923 $1,918
(premiums and co-pays)

Total $5,543 $5,143 $3,658 $3,653
Part A and Part B out-of-pocket costs

Part A: The amount you $300 a day for days $320 a day for days
1-7 in a network
will pay if you are No cost No cost hospital; $0 for days 1-6 in a network
hospital; $0
hospitalized 8-90. thereafter

Part B: Amounts owed Below are cost- fixed cost in
for most outpatient No cost after Part B sharing amounts network; 50% of Varies
deductible is paid
after Part B
services deductible is paid cost out ot network
Cost-sharing for doctors' office visits
=
In-Network Primary
Care Co-Pays $20 for doctors' $0 $0

In-Network Specialist No cost office visits and $50
Co-Pays for visit to $25 $45
Out-of-Network emergency room $35 primary care; $35 primary care;
Co-Pays $50 specialist $55 specialist

*This is 2020 Part B premium for new enrollees. Higher income people may pay more.
**Part B deductible in 2020 is $198.

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