Page 50 - Cover Letter and Evaluation for Bob Workman

10/25/2017 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 $4,060 Plan too new Enroll
Deductible: Plan Doctors Formulary :Yes to be
Pharmacy Drug: $0.00 $200 for Most measured
Status: Health: Services Drug Restrictions:
Preferred Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $566 Premium Coinsurance: $0 Limit: $5,900
Reduction - $90, 29% In-network MTM Program :
Mail Order :No Yes
Annual: $358
Premera Blue Cross Medicare Advantage Total Health (HMO)
(H7245-005-0)
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 $24.00 Annual Drug Doctor Choice: All Your Drugs on $4,130 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $20.40 $180 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $3.60 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $656 Premium Coinsurance: $2 Limit: $5,500
Reduction - $42, 29% - In-network MTM Program :
Mail Order :No 35% Yes
Annual: $633
AARP MedicareComplete Plan 2 (HMO) (H1286-009-0)
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 $55.00 Annual Drug Doctor Choice: All Your Drugs on $3,990 Enroll
Deductible: Plan Doctors Formulary :No
Pharmacy Drug: $40.40 $180 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Standard Cost- $14.60 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $718 Premium Coinsurance: $2 Limit: $4,200
Reduction - $95, 29% In-network MTM Program : This is not the
Mail Order :No Yes
Annual: $642 Humana Choice
HumanaChoice H5216-047 (PPO) (H5216-047-0) PPO plan that's
Organization: Humana Insurance Company compared in your
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
evaluation. This
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
plan has a $100
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
monthly premium
[?] Programs: Costs: [?]
Retail $100.00 Annual Drug Doctor Choice: All Your Drugs on $5,080 for medical care Enroll
Deductible: Any Doctor Formulary :Yes and Rx drugs.
Pharmacy Drug: $36.20 $320 4 out of 5
Status: Health: Out of Pocket Drug Restrictions: stars
Preferred Cost- $63.80 Health Plan Spending Yes
Sharing Deductible: $0 Limit: $10,000 Lower Your Drug
Part B Drug Copay/ In and Out-of- Costs
Annual: $734 Premium Coinsurance: $4 network
Reduction - $100, 26% $6,700 In- MTM Program :
Mail Order :No network Yes These are
Annual: $577 high costs

for your Rx
Community HealthFirst MA Pharmacy Plan (HMO) (H5826-008-0)
Organization: Community HealthFirst Medicare Advantage Plan drugs.

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