Page 161 - Cover Letter and Evaluation for Sue Marx

2/6/2019 Your Plan Results
Retail $35.00 Annual Drug Doctor All Your Drugs on $9,630 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4 out of 5
Pharmacy Drug: Doctor stars
Status: $35.00 Health Plan Drug Restrictions:
Standard Cost- Health: Deductible: Out of Pocket Yes
Sharing $0.00 $1,250 annual Spending Lower Your
deductible Limit: Drug Costs
Cost as of Part B Drug Copay/ $10,000 In
Today: $5,346 Premium Coinsurance: and Out-of- MTM Program :
Reduction: $0 - $95, 33% network Yes
Mail Order No $6,700 In-
Cost as of network
Today: $7,252
Advantra Silver (PPO) (H5522-018-0)
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 $27.00 Annual Drug Doctor All Your Drugs on $8,800 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4 out of 5
Pharmacy Drug: Doctor stars
Status: $26.70 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: Out of Pocket Yes
Sharing $0.30 $750 annual Spending Lower Your
deductible Limit: Drug Costs
Cost as of Part B Drug Copay/ $10,000 In
Today: $4,954 Premium Coinsurance: and Out-of- MTM Program :
Reduction: $0 - $100, 33% network Yes
Mail Order No $5,900 In-
Cost as of network
Today: $7,349

Aetna Medicare Silver Plan (HMO) (H3931-070-0)
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 $47.00 Annual Drug Doctor All Your Drugs on $9,180 Enroll
Deductible: $0 Choice: Plan Formulary: Yes 3.5 out of 5
Pharmacy Drug: Doctors for stars
Status: $32.00 Health Plan Most Services Drug Restrictions:
Preferred Cost- Health: Deductible: $0 Yes
Sharing $15.00 Drug Copay/ Out of Pocket Lower Your
Coinsurance: Spending Drug Costs
Cost as of Part B $0 - $100, 33% Limit: $6,700
Today: $5,007 Premium In-network MTM Program :
Reduction: Yes
Mail Order No
Cost as of
Today: $7,402
HumanaChoice H5525-017 (PPO) (H5525-017-0)
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: [?]

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