Page 20 - Cover letter and evaluation for Peter Smith

11/27/2017 Your Plan Results

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The four plans whose
Your Plan Results names are circled are
compared in your Zip Code: 89129
Current Coverage: Original Medicare
evaluation
Current Subsidy: No Extra Help [?]
Drug List ID: 2579428096
Your plan results are organized by plan type and are initially sorted by lowest Password Date: 11/23/2017
estimated cost. To view more plans, select View 20 or View All. Select any plan Important Coverage Information
name for details. Compare up to 3 plans by using the checkboxes and selecting
Compare Plans. The costs displayed are estimates; your actual costs may vary.

You are now viewing 2018 plan data. View 2017 plan data. This is a list of the 12 Medicare Advantage
plans in your zip code. This list is sorted by
the plans' costs for your Rx drugs if you get
Symbols
mail-order refills, with the lowest-cost plan
listed first. Rx drug costs include premiums,
Some Dental Coverage Some Vision Coverage Nationwide Coverage Some Hearing Coverage
deductibles, and co-payments.

Your Current Plan(s)
Original Medicare (H0001-001-0)
Includes Part A (Hospital Insurance) and/or Part B (Medical Insurance) - Excludes Part D Drug
Coverage
Estimated Monthly Deductibles: Health Benefits: [?] Drug Coverage [?] Estimated Overall Star
Annual Drug Premium: [?] and Drug , Drug Restrictions Annual Health Rating: [?]
Costs: [?] [?] Copay [?] / [?] and Drug Costs:
Coinsurance: [?]
[?]
Retail Standard Part B Doctor Choice: Any N/A $35,490 Not Available
Annual: $31,615 Part B: Deductible: $183 Willing Doctor Includes $31,615
$134 for drug costs
Out of Pocket Spending
Limit: Not Applicable

Medicare Health Plans with Drug Coverage

12 plans were found in 89129 based on your search criteria. View 10 View 12
This is the lowest-
cost plan for your
Sort Results by
drugs.
Anthem Value Plus (HMO) (H4346-001-0)
Organization: Anthem Blue Cross and Blue Shield
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $5,410 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 for Most 3.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Preferred Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $0 Spending Costs
Annual: $3,009 Premium - $85, 33% Limit: $2,500
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $2,840

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