Page 13 - Cover Letter and Evaluation for Gary Janke

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

Blue Advantage Blue Advantage Ruby
Plan name Medigap Plan G Medigap Plan N
Garnet PPO Plan PPO Plan

Toll-Free Number NA NA (800) 292-5146 (800) 292-5146

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 $1,500 $1,275 $0 $560
premiums are estimates)

Total $3,108 $2,883 $1,608 $2,168

Minimum costs for Medicare-covered services

Total medical premiums $3,108 $2,883 $1,608 $2,168
(from above)

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

Annual Rx costs, mail

order (premiums, $1,400 $1,400 $903 $1,480
deductibles, co-pays)
Total Minimum Costs
(includes cost-sharing for the $4,691 $4,466 $2,511 $3,648
Rx drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays $10 $15
No co-pays for You pay 5% of
In-Network Specialist Medicare-covered Medicare approved
Co-Pays services amount $35 $35
Out-of-Network
Co-Pays 50% of cost 50% of cost
*This is 2018 standard Part B premium for new enrollees who are not yet receiving Social Security benefits.
**Part B deductible in 2018 is $183.

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