Page 13 - Evaluation for Dirk Huybrechts

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

Aetna Medicare
Plan name Medigap Plan F Medigap Plan N Medigap Plan L
Choice PPO Plan

Toll-Free Number NA NA NA (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 $2,330 $1,830 $1,760 $725
premiums are estimates)

Total $3,938 $3,438 $3,368 $2,333

Minimum costs for Medicare-covered services

Total medical premiums $3,938 $3,438 $3,368 $2,333
(from above)

Plan health deductible
(includes Part B deductible if $0 $183 $183 $750
not covered by plan**)

Annual Rx costs
(premiums, deductibles, co- $410 $410 $410 $296
pays)

Total Minimum Costs
(includes cost-sharing for the $4,348 $4,031 $3,961 $3,379
Rx drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary

Care Co-Pays up to $20 for $10
No co-pays for Medicare-approved
In-Network Specialist Medicare-covered doctor's visit; $50 5% of Medicare-
Co-Pays services for emergency approved cost $40
Out-of-Network room visit

Co-Pays 40% of cost
*This is 2017 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 in 2017 is $183.

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