Page 164 - Cover Letter and Evaluation for Sue Marx

2/6/2019 Your Plan Results
Retail $135.00 Annual Drug Doctor All Your Drugs on $10,120 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4 out of 5
Pharmacy Drug: Doctor stars
Status: $58.40 Health Plan Drug Restrictions:
Standard Cost- Health: Deductible: Out of Pocket Yes
Sharing $76.60 $500 annual Spending Lower Your
deductible Limit: Drug Costs
Cost as of Part B Drug Copay/ $10,000 In
Today: $5,580 Premium Coinsurance: and Out-of- MTM Program :
Reduction: $0 - $95, 33% network Yes
Mail Order No $6,700 In-
Cost as of network
Today: $7,486

Humana Value Plus H5216-117 (PPO) (H5216-117-0)
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 $26.50 Annual Drug Doctor All Your Drugs on $9,850 Enroll
Deductible: Choice: Any Formulary: Yes 4 out of 5
Pharmacy Drug: $405 Doctor stars
Status: $26.50 Drug Restrictions:
Preferred Cost- Health: Health Plan Out of Pocket Yes
Sharing $0.00 Deductible: Spending Lower Your
$185 per year Limit: Drug Costs
Cost as of Part B for some in- $10,000 In
Today: $5,656 Premium network and and Out-of- MTM Program :
Reduction: out-of-network network Yes
Mail Order No services. $6,700 In-
Cost as of Drug Copay/ network
Today: $7,508 Coinsurance:
$0 - $100, 25%
UPMC for Life HMO Rx (HMO) (H3907-029-0)
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: [?]
Retail $81.00 Annual Drug Doctor All Your Drugs on $9,720 Enroll
Deductible: $0 Choice: Plan Formulary: Yes 4 out of 5
Pharmacy Drug: Doctors for stars
Status: $61.30 Health Plan Most Services Drug Restrictions:
Standard Cost- Health: Deductible: $0 Yes
Sharing $19.70 Drug Copay/ Out of Pocket Lower Your
Coinsurance: Spending Drug Costs
Cost as of Part B $0 - $95, 33% Limit: $3,400
Today: $5,609 Premium In-network MTM Program :
Reduction: Yes
Mail Order No
Cost as of
Today: $7,515
Security Blue HMO-POS ValueRx (HMO-POS) (H3957-031-0)
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: [?]

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