Page 14 - Cover Letter and Evaluation for Clay Bassett

Core Benefits
Medigap Plan Comparisons: This chart shows how much cost-sharing you
will have in each Medigap plan. Not included are payments for services that
Medicare does not cover like routine dental/vision care, hearing aids, benefits for A B
more than 100 days a skilled nursing facility, and so on.

Estimated annual premiums for a Connecticut resident* $1,950 $2,550
Each plan's benefits relative to Plan F 70.7% 85.6%
Coverage Area 2018 Coverage Gap

$335 daily co-pay for days 61-90;
Part A Hospital Co-Insurance $670 daily co-pay for days 91-150; You pay You pay
All plans cover 365 additional days. nothing nothing

Part A Skilled Nursing Facility Co- A $167.50 daily co-payment for days 21-100 in a
Insurance skilled nursing facility Not covered Not covered

Part A Hospice Care Co-Insurance 5% co-insurance for respite care; You pay
or Co-Payment $5 co-payment for inpatient drugs nothing You pay
nothing
Part A Hospital Deductible The $1,340 first-day deductible You pay $1,340

Part B Deductible In 2018 the Part B deductible is $183 You pay $183 You pay $183

20% of Medicare-approved amounts for most
Part B Co-Insurance or Co- services covered by Part B after the $183 You pay You pay
Payment nothing nothing
deductible is paid

In most states, providers who do not accept
assignment can charge up to 15% more than
Part B Excess Charges Not covered Not covered
Medicare-approved amounts. Three Medigap
plans cover these excess charges.

Medicare does not cover medical care outside
the United States. But the seven Medigap plans
Foreign Travel Emergencies** Not covered Not covered
indicated do offer some coverage for emergency
medical care in other countries.

You pay You pay
Blood First 3 pints of blood
nothing nothing

*Estimated annual premiums are based in most cases on your state insurance department's Medigap premium comparisons or
on quotes from an actuarial firm. There can be large variations in premiums from one company to another, and it's a good idea
to get several current quotes.

**Plans C, D, F, G, M, and N include benefits for foreign travel emergencies. These plans cover 80% of cost of medical
emergencies while traveling in other countries. This coverage has a $250 deductible and a $50,000 lifetime limit.

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