Page 160 - Cover Letter and Evaluation for Sue Marx

2/6/2019 Your Plan Results
Retail $22.00 Annual Drug Doctor All Your Drugs on $9,080 Enroll
Deductible: $0 Choice: Plan Formulary: Yes 4 out of 5
Pharmacy Drug: Doctors for stars
Status: $22.00 Health Plan Most Services Drug Restrictions:
Standard Cost- Health: Deductible: Yes
Sharing $0.00 $750 In- Out of Pocket Lower Your
network Spending Drug Costs
Cost as of Part B Drug Copay/ Limit: $4,000
Today: $5,216 Premium Coinsurance: In-network MTM Program :
Reduction: $0 - $95, 33% Yes
Mail Order No
Cost as of
Today: $7,122
AdvantraOne (PPO) (H5522-017-0)
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 $9,390 Enroll
Deductible: Choice: Any Formulary: Yes 4 out of 5
Pharmacy Drug: $0.00 $395 Doctor stars
Status: Health: Drug Restrictions:
Preferred Cost- $0.00 Health Plan Out of Pocket Yes
Sharing Deductible: Spending Lower Your
Part B $1,500 annual Limit: Drug Costs
Cost as of Premium deductible $10,000 In
Today: $5,436 Reduction: Drug Copay/ and Out-of- MTM Program :
Yes Coinsurance: network Yes
Mail Order $0 - $100, 25% $6,700 In-
Cost as of network
Today: $7,146

HumanaChoice H5525-038 (PPO) (H5525-038-0)
Organization: Humana
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 $8,760 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 $300 annual Spending Lower Your
Part B deductible Limit: Drug Costs
Cost as of Premium Drug Copay/ $10,000 In
Today: $4,690 Reduction: Coinsurance: and Out-of- MTM Program :
No $7 - $100, 33% network Yes
Mail Order $6,700 In-
Cost as of network
Today: $7,231

UPMC for Life PPO High Deductible with Rx (PPO) (H5533-003-0)
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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