Page 47 - Evaluation for 2018

This is one of the two
12/23/2017 Your Plan Results
Advantage plans
Humana Gold Plus H5619-060 (HMO) (H5619-060-0) compared in your
Organization: Arcadian Health Plan, Inc.
evaluation. Your
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?] doctors are all listed in
Costs: [?] [?] Copay [?] / Restrictions [?] Health and this plan's network, but
Coinsurance: and Other Drug
[?] Programs: Costs: [?] you should verify that
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $3,890 before enrolling.
Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 $180 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: Premium Coinsurance: $4 Limit: $5,900
Reduction - $100, 29% In-network MTM Program :
Mail Order :No Yes
Annual: $0
Allwell Medicare (HMO) (H0029-004-0)
Organization: Allwell
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $3,490 Plan too new Enroll
Deductible: Plan Doctors Formulary :Yes to be
Pharmacy Drug: $0.00 $200 for Most measured
Status: Health: Services Drug Restrictions:
Preferred Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: Premium Coinsurance: $0 Limit: $5,900
Reduction - $90, 29% In-network MTM Program :
Mail Order :No Yes
Annual: $0
Premera Blue Cross Medicare Advantage (HMO) (H7245-001-0)
Organization: Premera Blue Cross Medicare Advantage
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $3,700 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 $340 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $0.00 Health Plan No
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: Premium Coinsurance: $5 Limit: $6,200
Reduction - $42, 26% - In-network MTM Program :
Mail Order :No 35% Yes
Annual: $79
Kaiser Permanente Medicare Advantage Centennial (HMO) (H5050-
021-0)
Organization: Kaiser Foundation Health Plan of Washington
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $29.00 Annual Drug Doctor Choice: All Your Drugs on $6,490 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 $350 for Most 4.5 out of 5
Status: Health: Services Drug Restrictions: stars
Out-of-network $29.00 Health Plan Out of Pocket No
Deductible: $0
Annual: Part B Drug Copay/ Spending Lower Your Drug
Costs
Premium Coinsurance: $0 Limit: $6,700
Mail Order Reduction - $95, 25% In-network MTM Program :
Annual: $129 :No Yes

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