Page 13 - Cover Letter and Medicare Evaluation for Jamie Marshall

Plans that appear to meet your criteria (cont'd)

Plan name Medigap Plan G Medigap Plan N Medigap Plan L

Toll-Free Number NA NA NA

Estimated medical premiums for 2022
lity ratings from Medicare web site (best rating = 5 stars)
Standard Part B
$2,041 $2,041 $2,041
premium *
Health plan premiums
(Medigap premiums are $3,200 $2,600 $2,600
estimates)

Total $5,241 $4,641 $4,641

Minimum costs for Medicare-covered services

Total medical premiums $5,241 $4,641 $4,641
(from above)

Plan health deductible
(includes Part B deductible $233 $233 $233
if not covered by plan**)

Est. annual Rx costs $1,118 $1,118 $1,118
(premiums and co-pays)

Total Minimum Costs
(includes cost-sharing for $6,592 $5,992 $5,992
the Rx drugs you now take)

Cost-sharing for doctors' office visits
=
In-Network Primary After annual Part B
Care Co-Pays After Part B annual deductible is paid, you
No co-pays after the deductible is paid, up to
In-Network Specialist annual Part B deductible $20 co-pays for doctors' pay 5% of Medicare-
Co-Pays ($233) is paid office visits and $50 for approved amount for
Out-of-Network ER visit doctors' office visits and
other Part B services.
Co-Pays
*The 2022 standard Part B premium for new enrollees is $170.10 a month; higher income people may pay
more. **Part B deductible in 2022 is $233.

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