Page 64 - Cover Letter and Evaluation for Mike Peaseley
P. 64
11/17/2017 Your Medicare Health Plan Comparison
Monthly Premiums Monthly Premiums
2
2
Part B premium $134.00 Part B premium $134.00
View Part B premiums based on income View Part B premiums based on income
Plan premium $51.00 Plan premium $86.00
$26.40 $59.50
Health plan premium Health plan premium
$24.60 $26.50
Drug plan premium Drug plan premium
Estimated Costs Estimated Costs
*Inpatient care $30.00 *Inpatient care $24.00
*Outpatient prescription drugs $69.54 *Outpatient prescription drugs $69.54
*Dental services $40.00 *Dental services $36.00
*All other services $93.00 *All other services $81.00
Total monthly estimated costs: $417.54 Total monthly estimated costs: $430.54
3
3
TOTAL ESTIMATED ANNUAL COST : [?] $5,010 TOTAL ESTIMATED ANNUAL COST : [?] $5,170
How are Out-of-Pocket costs calculated? How are Out-of-Pocket costs calculated?
View estimated monthly Out-of-Pocket Costs (OOPC) for people View estimated monthly Out-of-Pocket Costs (OOPC) for people
with High-Cost Conditions (chronic care and unexpected illnesses) with High-Cost Conditions (chronic care and unexpected illnesses)
1 An out-of-pocket cost maximum applies for some services 1 An out-of-pocket cost maximum applies for some services
covered by this plan. covered by this plan.
2 Medicare costs at a glance 2 Medicare costs at a glance
3 Estimated Annual Costs are rounded to the nearest $10. 3 Estimated Annual Costs are rounded to the nearest $10.
They don't include any Medicare Part D (prescription drug) They don't include any Medicare Part D (prescription drug)
late enrollment penalty amounts that may apply to you. Also, late enrollment penalty amounts that may apply to you. Also,
if you have limited income and resources, your expenses may if you have limited income and resources, your expenses may
be lower. be lower.
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