Page 15 - Cover Letter and Medicare Evaluation for Heidi Bathon

Comprehensive Benefits Comprehensive Benefits with Higher Cost-Sharing

High
C D F G Deductible K L M N
Plan F or G*

$3,050 $3,000 $3,100 $2,800 $1,600 $1,700 $2,250 $2,400 $2,350
99.7% 97.1% 100.0% 97.3% 43.5% 53.5% 72.6% 84.2% 71.5%
Co-Payments and Cost-Sharing

You pay You pay
nothing nothing

You pay You pay You pay
You pay You pay After you $92.75 a day $46.37 a day' nothing You pay
nothing nothing have paid nothing

the plan's You pay You pay
You pay $2,370 2.5% & 1.25% &
$2.50
nothing deductible, You pay $1.25 You pay
You pay you will $742 You pay $371 $742

You pay nothing You pay have no You pay You pay $203 You pay You pay
$203 $203 further cost- $203 $203 $203
sharing for You pay 10% You pay 5%
$20 for
You pay Medicare- of Medicare- of Medicare- You pay doctor's office
covered
nothing services. approved approved nothing visits; $50 for
You pay amount amount an ER visit
nothing
Not Not Not covered Not covered Not Not
covered covered covered covered

Some
Some Some Some Some Some Some
coverage* coverage* coverage* coverage coverage* Not covered Not covered coverage* coverage*
*

You pay You pay You pay You pay You pay You pay 10% You pay 5% You pay You pay
nothing nothing nothing nothing nothing of cost of cost nothing nothing
* High 2021 high-deductible amount $2,320
Deductible F
& G are 2021 Out-of-Pocket Limit $6,220 $3,110
identical
*** Out-of-pocket limits do not include plan premiums. Nor do they apply to services that are not covered. In
Plans K and L, for example, the Part B deductible is not covered. Thus any money you spend for the Part B
deductible does not count toward the OOP limit.

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