Page 163 - Cover Letter and Evaluation for Sue Marx

2/6/2019 Your Plan Results
Retail $123.00 Annual Drug Doctor All Your Drugs on $9,600 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4 out of 5
Pharmacy Drug: Doctor stars
Status: $23.10 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: $0 Out of Pocket Yes
Sharing $99.90 Drug Copay/ Spending Lower Your
Coinsurance: Limit: Drug Costs
Cost as of Part B $5 - $97, 33% $10,000 In
Today: $4,921 Premium and Out-of- MTM Program :
Reduction: network Yes This plan is
Mail Order No $6,700 In- compared in your
Cost as of network
Today: $7,462 evaluation

Advantra Gold (PPO) (H5522-001-0)
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 $47.00 Annual Drug Doctor All Your Drugs on $8,750 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4 out of 5
Pharmacy Drug: Doctor stars
Status: $39.30 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: Out of Pocket Yes
Sharing $7.70 $750 annual Spending Lower Your
deductible Limit: Drug Costs
Cost as of Part B Drug Copay/ $10,000 In
Today: $5,080 Premium Coinsurance: and Out-of- MTM Program :
Reduction: $0 - $100, 33% network Yes
Mail Order No $5,900 In-
Cost as of network
Today: $7,475

Aetna Medicare Gold Plan (PPO) (H5521-122-0)
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 $147.00 Annual Drug Doctor All Your Drugs on $10,010 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4 out of 5
Pharmacy Drug: Doctor stars
Status: $39.80 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: Out of Pocket Yes
Sharing $107.20 $500 annual Spending Lower Your
deductible Limit: $7,500 Drug Costs
Cost as of Part B Drug Copay/ In and Out-
Today: $5,085 Premium Coinsurance: of-network MTM Program :
Reduction: $0 - $100, 33% $4,500 In- Yes
Mail Order No network
Cost as of
Today: $7,480
UPMC for Life PPO Rx Enhanced (PPO) (H5533-005-0)
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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