Page 7 - Cover Letter and Evaluation for Anne Parlin
P. 7
Plans that appear to meet your criteria (cont'd)
Medigap Plan F and Rx drug costs in NY Medigap Plan F and Rx drug costs in
Plan name
zip code 12874 Vermont zip code 05403
Rx drug refill schedule Monthly Mail Order Monthly Mail Order
Estimated annual premiums for medical coverage
lity ratings from Medicare web site (best rating = 5 stars)
2017 standard Part B
premium of $134 a $1,608 $1,608 $1,608 $1,608
month*
Estimated Medigap Plan
F premiums $2,750 $2,750 $2,200 $2,200
Total $4,358 $4,358 $3,808 $3,808
Minimum costs for Medicare-covered services
Total medical premiums $4,358 $4,358 $3,808 $3,808
(from above)
Plan health deductible
(includes Part B deductible if not $0 $0 $0 $0
covered by plan**)
Annual Rx costs (premiums, $320 $311 $322 $311
deductibles, co-pays)
Total Minimum Costs
(includes cost-sharing for the Rx $4,678 $4,669 $4,130 $4,119
drugs you now take)
Cost-sharing for doctors office visits
=
In-Network Primary
Care Co-Pays
In-Network Specialist No co-pays for Medicare-covered No co-pays for Medicare-covered
Co-Pays services services
Out-of-Network
Co-Pays
*This is 2017 standard Part B premium for new enrollees who are not yet receiving Social Security benefits.
**Part B deductible in 2017 is $183.
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