Page 13 - Cover Letter and Evaluation for Anne Ellzey

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 $109 a $1,308 $1,308 $1,308 $1,308
month*

Health plan annual
premiums (Medigap $1,750 $1,550 $1,150 $1,025
premiums are estimates)

Total $3,058 $2,858 $2,458 $2,333

Minimum costs for Medicare-covered services

Total medical premiums
(from above) $3,058 $2,858 $2,458 $2,333

Plan health deductible

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

Annual Rx costs, retail
refills (premiums, $4,217 $4,217 $4,217 $4,217
deductibles, co-pays)
Total Minimum Costs

(includes cost-sharing for the $7,275 $7,258 $6,858 $6,733
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 2018 Part B premium for new enrollees who are already receiving Social Security benefits. Higher income
people may pay more. **Part B deductible is $183.

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