Page 30 - APPENDICES for Neill McLauchlin
P. 30
Doesn't include: $148.50 Standard Part B premium
YEARLY DRUG & PREMIUM COST
$1,011.09 Mail-order pharmacy: Estimated total drug + premium cost
Doesn't include: Health costs
OTHER COSTS
$0 Health deductible
$0.00 Drug deductible
$3,900 In-network Maximum you pay for health services
Blue Medicare Essential Plus (HMO)
Blue Cross and Blue Shield of North Carolina | Plan ID: H3449-023-1
Star rating:
MONTHLY PREMIUM
$0.00 Includes: Health & drug coverage
Doesn't include: $148.50 Standard Part B premium
YEARLY DRUG & PREMIUM COST
$1,011.09 Mail-order pharmacy: Estimated total drug + premium cost
Doesn't include: Health costs
OTHER COSTS
$0 Health deductible
$195.00 Drug deductible
$4,200 In-network Maximum you pay for health services
