Page 166 - Cover Letter and Evaluation for Sue Marx

2/6/2019 Your Plan Results
Retail $172.00 Annual Drug Doctor All Your Drugs on $10,510 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4.5 out of 5
Pharmacy Drug: Doctor stars
Status: $83.40 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: $0 Out of Pocket Yes
Sharing $88.60 Drug Copay/ Spending Lower Your
Coinsurance: Limit: Drug Costs
Cost as of Part B $0 - $95, 33% $10,000 In
Today: $5,828 Premium and Out-of- MTM Program :
Reduction: network Yes
Mail Order No $5,500 In-
Cost as of network
Today: $7,773

Security Blue HMO-POS Standard (HMO-POS) (H3957-003-0)
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: [?]
Retail $201.50 Annual Drug Doctor All Your Drugs on $10,900 Enroll
Deductible: $0 Choice: Plan Formulary: Yes 4.5 out of 5
Pharmacy Drug: Doctors Only stars
Status: $100.50 Health Plan (some Drug Restrictions:
Standard Cost- Health: Deductible: $0 exceptions) Yes
Sharing $101.00 Drug Copay/ Lower Your
Coinsurance: Out of Pocket Drug Costs
Cost as of Part B $0 - $100, 33% Spending
Today: $6,049 Premium Limit: MTM Program :
Reduction: $10,000 In Yes
Mail Order No and Out-of-
Cost as of network
Today: $7,944 $5,500 In-
network

Freedom Blue PPO Classic (PPO) (H3916-001-0)
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 $293.00 Annual Drug Doctor All Your Drugs on $11,810 Enroll
Deductible: $0 Choice: Any Formulary: Yes 4.5 out of 5
Pharmacy Drug: Doctor stars
Status: $102.80 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: $0 Out of Pocket Yes
Sharing $190.20 Drug Copay/ Spending Lower Your
Coinsurance: Limit: Drug Costs
Cost as of Part B $0 - $95, 33% $10,000 In
Today: $6,033 Premium and Out-of- MTM Program :
Reduction: network Yes
Mail Order No $4,900 In-
Cost as of network
Today: $7,967

Community Blue Medicare HMO Prestige (HMO) (H3957-039-0)
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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