Page 158 - Cover Letter and Evaluation for Sue Marx

2/6/2019 Your Plan Results This plan is
UPMC for Life HMO Premier Rx (HMO) (H3907-046-0) compared in your
Organization: UPMC for Life evaluation
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $8,670 Enroll
Deductible: $0 Choice: Plan Formulary: Yes 4 out of 5
Pharmacy Drug: $0.00 Doctors for stars
Status: Health: Health Plan Most Services Drug Restrictions:
Standard Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your
Part B Coinsurance: Spending Drug Costs
Cost as of Premium $0 - $42, 33% Limit: $6,000
Today: $4,996 Reduction: - 45% In-network MTM Program :
No Yes
Mail Order
Cost as of
Today: $6,902
Community Blue Medicare HMO Signature (HMO) (H3957-038-0)
Organization: Highmark Choice Company
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $8,630 Enroll
Deductible: $0 Choice: Plan Formulary: Yes 4.5 out of 5
Pharmacy Drug: $0.00 Doctors for stars
Status: Health: Health Plan Most Services Drug Restrictions:
Preferred Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your
Part B Coinsurance: Spending Drug Costs
Cost as of Premium $0 - $95, 33% Limit: $6,700
Today: $4,993 Reduction: In-network MTM Program :
Yes Yes
Mail Order
Cost as of
Today: $6,935
Community Blue Medicare PPO Signature (PPO) (H3916-035-1)
Organization: Highmark Senior Health Company
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $13.00 Annual Drug Doctor All Your Drugs on $9,100 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4.5 out of 5
Pharmacy Drug: Doctor stars
Status: $12.90 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: $0 Out of Pocket Yes
Sharing $0.10 Drug Copay/ Spending Lower Your
Coinsurance: Limit: Drug Costs
Cost as of Part B $0 - $95, 33% $10,000 In
Today: $5,123 Premium and Out-of- MTM Program :
Reduction: network Yes
Mail Order No $6,700 In-
Cost as of network
Today: $7,068

Advantra Silver (HMO) (H3959-010-0)
Organization: Coventry Health Care
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]

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