Page 13 - Cover Letter & Evaluation for Isaac Kapon
P. 13
Plans that appear to meet your criteria (cont'd)
Humana Choice
Plan name Medigap Plan F Medigap Plan L PPO Plan Aetna Medicare
Choice PPO Plan
(H5216-141)
Toll-Free Number NA NA (800) 833-2364 (855) 338-7027
Estimated annual premiums for medical coverage
lity ratings from Medicare web site (best rating = 5 stars)
2017 standard Part B
premium of $134 a $1,608 $1,608 $1,608 $1,608
month*
Health plan annual
premiums (Medigap $1,950 $1,250 $0 $0
premiums are estimates)
Total $3,558 $2,858 $1,608 $1,608
Minimum costs for Medicare-covered services
Total medical premiums $3,558 $2,858 $1,608 $1,608
(from above)
Plan health deductible
(includes Part B deductible if $0 $183 $1,500 $750
not covered by plan**)
Annual Rx costs
(premiums, deductibles, co- $204 $204 $0 $552
pays)
Total Minimum Costs
(includes cost-sharing for the $3,762 $3,245 $3,108 $2,910
Rx drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays $5 $5
No co-pays for You pay 5% of
In-Network Specialist Medicare-covered Medicare approved
Co-Pays services amount $45 $45
Out-of-Network
Co-Pays 40% of cost 40% of cost
*This is 2017 standard Part B premium for new enrollees who are not yet receiving Social Security benefits.
**Part B deductible in 2017 is $183.
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