Page 48 - Evaluation for 2018

12/23/2017 Your Plan Results This is the other Advantage
AARP MedicareComplete Plan 1 (HMO) (H1286-002-0) plan compared in your
Organization: UnitedHealthcare evaluation. All three of your
doctors are listed in this
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and plan's network, but you
Coinsurance: and Other Drug should verify that prior to
[?] Programs: Costs: [?]
enrolling.
Retail $17.00 Annual Drug Doctor Choice: All Your Drugs on $3,740 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $17.00 $180 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Standard Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: Premium Coinsurance: $2 Limit: $5,500
Reduction - $95, 29% In-network MTM Program :
Mail Order :No Yes
Annual: $204
Premera Blue Cross Medicare Advantage Total Health (HMO)
(H7245-005-0)
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 $24.00 Annual Drug Doctor Choice: All Your Drugs on $3,790 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $20.40 $180 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $3.60 Health Plan No
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: Premium Coinsurance: $2 Limit: $5,500
Reduction - $42, 29% - In-network MTM Program :
Mail Order :No 35% Yes
Annual: $288
Kaiser Permanente Medicare Advantage Columbia (HMO) (H5050-
019-0)
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 $99.00 Annual Drug Doctor Choice: All Your Drugs on $6,890 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $28.40 for Most 4.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Out-of-network $70.60 Deductible: $0 No
Drug Copay/ Out of Pocket Lower Your Drug
Annual: Part B Coinsurance: $0 Spending Costs
Premium - $90, 33% Limit: $4,500
Mail Order Reduction In-network MTM Program :
Annual: $428 :No Yes

HumanaChoice H5216-047 (PPO) (H5216-047-0)
Organization: Humana Insurance Company
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 $100.00 Annual Drug Doctor Choice: All Your Drugs on $5,050 Enroll
Deductible: Any Doctor Formulary :Yes
Pharmacy Drug: $36.20 $320 4 out of 5
Status: Health: Out of Pocket Drug Restrictions: stars
Preferred Cost- $63.80 Health Plan Spending Yes
Sharing Deductible: $0 Limit: $10,000 Lower Your Drug
Part B Drug Copay/ In and Out-of- Costs
Annual: Premium Coinsurance: $4 network
Reduction - $100, 26% $6,700 In- MTM Program :
Mail Order :No network Yes
Annual: $434

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