Page 13 - Cover Letter and Evaluation for Kirk Schmidt

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

Plan name Medigap Plan F Medigap Plan G Medigap Plan N Medigap Plan L

Toll-Free Number NA NA NA NA

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 $1,800 $1,600 $1,300 $1,225
premiums are estimates)

Total $3,408 $3,208 $2,908 $2,833

Minimum costs for Medicare-covered services

Total medical premiums
(from above) $3,408 $3,208 $2,908 $2,833

Plan health deductible

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

Annual Rx costs, mail-
order (premiums, $892 $892 $892 $892
deductibles, co-pays)
Total Minimum Costs

(includes cost-sharing for the $4,300 $4,283 $3,983 $3,908
Rx drugs you now take)

Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays up to $20 for
No co-pays for
No co-pays for
In-Network Specialist Medicare-covered Medicare-covered Medicare-approved 5% of Medicare-
doctor's visit; $50
Co-Pays services services for emergency approved cost
Out-of-Network room visit

Co-Pays
*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 is $183.

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