Page 13 - Cover letter and evaluation for Jack Hosier

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

Plan name Medigap Plan F Medigap Plan G Medigap Plan N Medigap Plan L

Toll-Free Number NA NA NA NA
Estimated annual premiums for medical coverage
lity ratings from Medicare web site (best rating = 5 stars)
2018 standard Part B
premium of $134 a $1,608 $1,608 $1,608 $1,608
month*

Health plan annual

premiums (Medigap $2,400 $2,200 $1,625 $1,340
premiums are estimates)

Total $4,008 $3,808 $3,233 $2,948

Minimum costs for Medicare-covered services

Total medical premiums $4,008 $3,808 $3,233 $2,948
(from above)

Plan health deductible

(includes Part B deductible if $0 $183 $183 $183
not covered by plan**)

Annual Rx costs (mail- $341 $341 $341 $341
order refills )

Total Minimum Costs
(includes cost-sharing for the $4,349 $4,332 $3,757 $3,472
Rx drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays up to $20 for
No co-pays for No co-pays for Medicare-approved
In-Network Specialist Medicare-covered Medicare-covered doctor's visit; $50 5% of Medicare-
Co-Pays services services for emergency approved cost
Out-of-Network room visit

Co-Pays
*This is 2018 Part B premium for new enrollees who are not yet receiving Social Security benefits. People who
have already started their Social Security benefits will pay $109 a month ($1,308 a year). Higher income people
may pay more. **Part B deductible is $183 in 2017.

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