Page 37 - Cover Letter and Evaluation for Amy Prack

Retail $0.00 Annual Drug Doctor All Your Drugs on $4,190 Enroll
Deductible: $225 Choice: Formulary: Yes 4 out of 5
Pharmacy Drug: $0.00 Plan stars
Status: Health: $0.00 Health Plan Doctors for Drug Restrictions:
Standard Deductible: $0 Most Yes
Cost-Sharing Part B Drug Copay/ Services Lower Your Drug
Premium Coinsurance: $3 - Costs
Cost as of Reduction: $100, 28% Out of
Today: $577 No Pocket MTM Program : Yes
Spending
Mail Order Limit:
Cost as of $6,000 In-
Today: $618 network

AARP MedicareComplete Choice (PPO) (H8768-007-0)
Organization: UnitedHealthcare
Estimated Monthly Deductibles [?] Health Drug Coverage [?] Estimated Overall
Annual Drug Premium: and Drug Copay Benefits: , Drug Restrictions Annual Health Star
Costs: [?] [?] [?] / Coinsurance: [?] [?] and Other and Drug Rating: [?]
[?] Programs: Costs: [?]
Retail $43.00 Annual Drug Doctor All Your Drugs on $4,330 Plan too Enroll
Deductible: $170 Choice: Formulary: Yes new to be
Pharmacy Drug: $29.70 Any Doctor measured
Status: Health: Health Plan Drug Restrictions:
Standard $13.30 Deductible: $0 Out of Yes
Cost-Sharing Drug Copay/ Pocket Lower Your Drug
Part B Coinsurance: $2 - Spending Costs
Cost as of Premium $95, 29% Limit:
Today: $586 Reduction: $10,000 In MTM Program : Yes
No and Out-
Mail Order of-network
Cost as of $4,500 In-
Today: $583 network

HumanaChoice H5216-109 (PPO) (H5216-109-0)
Organization: Humana
Estimated Monthly Deductibles [?] Health Drug Coverage [?] Estimated Overall
Annual Drug Premium: and Drug Copay Benefits: , Drug Restrictions Annual Health Star
Costs: [?] [?] [?] / Coinsurance: [?] [?] and Other and Drug Rating:
[?] Programs: Costs: [?] [?]
Retail $19.00 Annual Drug Doctor All Your Drugs on $4,360 Enroll
Deductible: $150 Choice: Formulary: Yes 4 out of 5
Pharmacy Drug: $19.00 Any Doctor stars
Status: Health: $0.00 Health Plan Drug Restrictions:
Preferred Deductible: $0 Out of Yes
Cost-Sharing Part B Drug Copay/ Pocket Lower Your Drug
Premium Coinsurance: $2 - Spending Costs
Cost as of Reduction: $100, 30% Limit:
Today: $604 No $10,000 In MTM Program : Yes
and Out-of-
Mail Order network
Cost as of $5,500 In-
Today: $676 network

MedMutual Advantage Choice (HMO) (H6723-002-1)
Organization: Medical Mutual of Ohio
Estimated Monthly Deductibles [?] Health Drug Coverage [?] Estimated Overall
Annual Drug Premium: and Drug Copay Benefits: , Drug Restrictions Annual Health Star
Costs: [?] [?] [?] / Coinsurance: [?] [?] and Other and Drug Rating:
[?] Programs: Costs: [?] [?]