Page 63 - Cover Letter & Evaluation for Patricia Letizia
P. 63
10/11/2018 Your Medicare Health Plan Details
Plan Type: Local Preferred Provider Organization
Plan Status: Approved by Medicare
Area: Milwaukee Metropolitan Area
View plan website
Important Note:
This plan does not charge an annual deductible for all drugs. The $95.00 annual deductible only applies to drugs on certain tiers.
View Drug Benefit Summary
Provider Network: 6001-6500 physicians and providers.
View provider and physician network website
View a chart on how an independent sales agent or broker would be compensated if they were to enroll you in a plan for 2019.
Costs
Monthly Premiums
2
Part B premium $134.00
View Part B premiums based on income
Plan premium $24.00
Health plan premium $7.00
Drug plan premium $17.00
Estimated Costs
*Inpatient care $21.00
*Outpatient prescription drugs $0.00
*Dental services $25.00
*All other services
$54.00
Total monthly estimated costs
$258.00
3
TOTAL ESTIMATED ANNUAL COSTS [?] $3,100
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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