Page 113 - Cover Letter and Evaluation for John
P. 113
10/9/2018 Your Medicare Health Plan Details
Provider Network: 12001-13000 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 $81.00
Health plan premium $41.40
Drug plan premium $39.60
Estimated Costs
*Inpatient care $19.00
*Outpatient prescription drugs $275.79
*Dental services $42.00
*All other services
$90.00
Total monthly estimated costs
$641.79
3
TOTAL ESTIMATED ANNUAL COSTS [?] $7,700
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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