Page 49 - Cover Letter and Evaluation for Bob Workman

10/25/2017 Your Plan Results
Humana Gold Plus H5619-102 (HMO) (H5619-102-0)
Organization: Arcadian Health Plan, Inc.
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 $33.00 Annual Drug Doctor Choice: All Your Drugs on $3,950 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 $150 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $33.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $300 Premium Coinsurance: $4 Limit: $5,000
Reduction - $100, 30% In-network MTM Program :
Mail Order :No Yes
Annual: $143
AARP MedicareComplete Plan 1 (HMO) (H1286-002-0)
Organization: UnitedHealthcare
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 $17.00 Annual Drug Doctor Choice: All Your Drugs on $3,910 Enroll
Deductible: Plan Doctors Formulary :No
Pharmacy Drug: $17.00 $180 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Standard Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $438 Premium Coinsurance: $2 Limit: $5,500
Reduction - $95, 29% In-network MTM Program :
Mail Order :No Yes
Annual: $361
Premera Blue Cross Medicare Advantage (HMO) (H7245-001-0)
Organization: Premera Blue Cross Medicare Advantage
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 $4,110 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 $340 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $514 Premium Coinsurance: $5 Limit: $6,200
Reduction - $42, 26% - In-network MTM Program :
Mail Order :No 35% Yes
Annual: $461
Community HealthFirst MA Extra Plan (HMO) (H5826-010-0)
Organization: Community HealthFirst Medicare Advantage Plan
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 $20.90 Annual Drug Doctor Choice: All Your Drugs on $4,290 Enroll
Deductible: $0 Plan Doctors Formulary :No
Pharmacy Drug: $20.90 for Most 3.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Standard Cost- $0.00 Deductible: $0 No
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $2 Spending Costs
Annual: $549 Premium - $47, 25% - Limit: $6,700
Reduction 33% In-network MTM Program :
Mail Order :No Yes
Annual: $533
Allwell Medicare (HMO) (H0029-004-0)
Organization: Allwell

https://www.medicare.gov/find-a-plan/results/planresults/plan-list.aspx 2/5