Page 165 - Cover Letter and Evaluation for Sue Marx

2/6/2019 Your Plan Results
Retail $65.00 Annual Drug Doctor All Your Drugs on $9,490 Enroll
Deductible: $0 Choice: Plan Formulary: Yes 4.5 out of 5
Pharmacy Drug: Doctors Only stars
Status: $62.70 Health Plan (some Drug Restrictions:
Preferred Cost- Health: Deductible: $0 exceptions) Yes
Sharing $2.30 Drug Copay/ Lower Your
Coinsurance: Out of Pocket Drug Costs
Cost as of Part B $0 - $95, 33% Spending
Today: $5,621 Premium Limit: MTM Program :
Reduction: $10,000 In Yes
Mail Order No and Out-of-
Cost as of network
Today: $7,566 $5,900 In-
network

Freedom Blue PPO ValueRx (PPO) (H3916-032-0)
Organization: Highmark Senior Health 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: [?]
Retail $77.00 Annual Drug Doctor All Your Drugs on $9,640 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4.5 out of 5
Pharmacy Drug: Doctor stars
Status: $66.00 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: $0 Out of Pocket Yes
Sharing $11.00 Drug Copay/ Spending Lower Your
Coinsurance: Limit: Drug Costs
Cost as of Part B $0 - $95, 33% $10,000 In
Today: $5,654 Premium and Out-of- MTM Program :
Reduction: network Yes
Mail Order No $5,900 In-
Cost as of network
Today: $7,599

UPMC for Life HMO Rx Enhanced (HMO) (H3907-006-0)
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 $290.00 Annual Drug Doctor All Your Drugs on $11,670 Enroll
Deductible: $0 Choice: Plan Formulary: Yes 4 out of 5
Pharmacy Drug: Doctors for stars
Status: $77.50 Health Plan Most Services Drug Restrictions:
Standard Cost- Health: Deductible: $0 Yes
Sharing $212.50 Drug Copay/ Out of Pocket Lower Your
Coinsurance: Spending Drug Costs
Cost as of Part B $0 - $95, 33% Limit: $3,400
Today: $5,771 Premium In-network MTM Program :
Reduction: Yes
Mail Order No
Cost as of
Today: $7,677
Freedom Blue PPO Select (PPO) (H3916-022-0)
Organization: Highmark Senior Health 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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