Page 77 - Cover Letter and Evaluation for Mike Peaseley
P. 77
11/17/2017 Your Medicare Health Plan Details
View Drug Benefit Summary
Provider Network: 16001-17000 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 2018
Costs
Monthly Premiums
2
Part B premium $134.00
View Part B premiums based on income
Plan premium $0.00
Health plan premium $0.00
Drug plan premium $0.00
Estimated Costs
*Inpatient care $35.00
*Outpatient prescription drugs $69.54
*Dental services $40.00
*All other services
$81.00
Total monthly estimated costs
$359.54
3
TOTAL ESTIMATED ANNUAL COSTS [?] $4,310
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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