Page 159 - Cover Letter and Evaluation for Sue Marx

2/6/2019 Your Plan Results
Retail $0.00 Annual Drug Doctor All Your Drugs on $8,570 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 - $100, 33% Limit: $6,700
Today: $4,687 Reduction: In-network MTM Program :
No Yes
Mail Order
Cost as of
Today: $7,082
Advantra Choice Plan (HMO) (H3959-043-0)
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: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $8,700 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: Yes
Sharing $495 In- Out of Pocket Lower Your
Part B network Spending Drug Costs
Cost as of Premium Drug Copay/ Limit: $6,700
Today: $4,687 Reduction: Coinsurance: In-network MTM Program :
No $0 - $100, 33% Yes
Mail Order
Cost as of
Today: $7,082
Aetna Medicare Silver (PPO) (H5521-261-0)
Organization: Aetna Medicare
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 $8,620 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4 out of 5
Pharmacy Drug: $0.00 Doctor stars
Status: Health: Health Plan Drug Restrictions:
Preferred Cost- $0.00 Deductible: Out of Pocket Yes
Sharing $950 annual Spending Lower Your
Part B deductible Limit: Drug Costs
Cost as of Premium Drug Copay/ $10,000 In
Today: $4,704 Reduction: Coinsurance: and Out-of- MTM Program :
No $2 - $100, 33% network Yes
Mail Order $6,700 In-
Cost as of network
Today: $7,088

UPMC for Life HMO Deductible with Rx (HMO) (H3907-037-0)
Organization: UPMC for Life
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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