Page 13 - Cover Letter and Evaluation for John

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

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

Toll-Free Number NA NA NA (833) 859-6031

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 $2,000 $1,800 $1,500 $497
premiums are estimates)

Total $3,608 $3,408 $3,108 $2,105

Minimum costs for Medicare-covered services

Total medical premiums $3,608 $3,408 $3,108 $2,105
(from above)

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

Annual Rx costs, mail-
order refills (premiums, $3,056 $3,056 $3,056 $3,785
deductibles, co-pays)

Total Minimum Costs
(includes cost-sharing for the $6,664 $6,647 $6,347 $6,640
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 No co-pays for Medicare-approved
In-Network Specialist doctor's visit; $50
Medicare-covered Medicare-covered
Co-Pays services services. for emergency $40
Out-of-Network room visit.

Co-Pays 40% of cost
*This is the 2018 Part B premium for new enrollees. Higher income people may pay more.
**Part B deductible in 2018 is $183.

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