Page 22 - Cover letter and evaluation for Peter Smith

11/27/2017 Your Plan Results
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 $6,330 Enroll
Deductible: $0 Plan Doctors Formulary :No
Pharmacy Drug: $0.00 for Most 4 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: $2 Spending Costs
Annual: $3,939 Premium - $100, 33% Limit: $1,900
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $5,393
Aetna Medicare Select Plan (HMO) (H3931-094-0)
Organization: Aetna Medicare
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 $6,910 Enroll
Deductible: $0 Plan Doctors Formulary :No
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: $2 Spending Costs
Annual: $4,039 Premium - $100, 33% Limit: $4,500
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $5,463
Aetna Medicare Choice Plan (PPO) (H5521-055-0)
Organization: Aetna Medicare
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 $46.00 Annual Drug Doctor Choice: All Your Drugs on $7,950 Enroll
Deductible: $75 Any Doctor Formulary :No
Pharmacy Drug: $46.00 4 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Standard Cost- $0.00 Deductible: Spending Yes
Sharing $750 annual Limit: $10,000 Lower Your Drug
Part B deductible In and Out-of- Costs
Annual: $4,586 Premium Drug Copay/ network
Reduction Coinsurance: $3 $6,700 In- MTM Program :
Mail Order :No - $100, 31% network Yes
Annual: $6,053

Aetna Medicare Select Plan (PPO) (H5521-022-0)
Organization: Aetna Medicare
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 $96.00 Annual Drug Doctor Choice: All Your Drugs on $8,250 Enroll
Deductible: $0 Any Doctor Formulary :No
Pharmacy Drug: $52.30 4 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Standard Cost- $43.70 Deductible: Spending Yes
Sharing $750 annual Limit: $8,200 Lower Your Drug
Part B deductible In and Out-of- Costs
Annual: $4,686 Premium Drug Copay/ network
Reduction Coinsurance: $3 $5,000 In- MTM Program :
Mail Order :No - $100, 33% network Yes
Annual: $6,108

HumanaChoice H5216-141 (PPO) (H5216-141-0)
Organization: Humana Insurance Company

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