Page 151 - Cover Letter and Evaluation for Gary Janke
P. 151
10/8/2018 Your Medicare Health Plan Details
Provider Network: 18001-19000 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 2019.
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 $24.00
*Outpatient prescription drugs $95.59
*Dental services $28.00
*All other services
$106.00
Total monthly estimated costs
$387.59
3
TOTAL ESTIMATED ANNUAL COSTS [?] $4,650
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.
Return to previous page
https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=H7917&plnid=032&sgmntid=0 2/2