Page 10 - Cover letter and evaluation for Thomas Barr

10/14/2017 Your Plan Results
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 $37.00 Annual Drug Doctor Choice: All Your Drugs on $4,370 Enrollment begins
Deductible: Plan Doctors Formulary :Yes October 15, 2017
Pharmacy Drug: $29.30 $405 for Most This plan got
Status: Health: Services Drug Restrictions: Medicare's
Standard Cost- $7.70 Health Plan No highest
Sharing Deductible: $0 Out of Pocket Lower Your Drug rating (5
Part B Drug Copay/ Spending Costs stars)
Annual: $400 Premium Coinsurance: Limit: $6,700
Reduction 25% In-network MTM Program : This plan is
Mail Order :No Yes compared in your
Annual: $382
evaluation
Johns Hopkins Advantage MD (PPO) (H3890-001-0)
Organization: Johns Hopkins HealthCare
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 $47.00 Annual Drug Doctor Choice: All Your Drugs on $4,380 Enrollment begins
Deductible: $0 Any Doctor Formulary :Yes October 15, 2017
Pharmacy Drug: $41.30 2.5 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Standard Cost- $5.70 Deductible: $0 Spending No
Sharing Drug Copay/ Limit: $10,000 Lower Your Drug
Part B Coinsurance: $7 In and Out-of- Costs
Annual: $512 Premium - $95, 33% network
Reduction $6,700 In- MTM Program :
Mail Order :No network Yes
Annual: $504
I did not choose
Johns Hopkins Advantage MD Plus (PPO) (H3890-002-0) this Johns Hopkins
Organization: Johns Hopkins HealthCare
plan because its
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Rating: [?]
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual combined monthly
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
premium is $360+
Coinsurance: and Other Drug
[?] Programs: Costs: [?] more a year than
Retail $78.00 Annual Drug Doctor Choice: All Your Drugs on $4,490 the other Johns
Enrollment begins
Deductible: $0 Any Doctor Formulary :Yes October 15, 2017
2.5 out of 5
Pharmacy Drug: $40.40 Hopkins PPO plan.
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Standard Cost- $37.60 Deductible: $0 Spending No
Sharing Drug Copay/ Limit: $10,000 Lower Your Drug
Part B Coinsurance: $4 In and Out-of- Costs
Annual: $501 Premium - $92, 33% network
Reduction $5,900 In- MTM Program :
Mail Order :No network Yes
Annual: $493

Notes:
Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
Extra Help from Medicare paying your drug costs.

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