Page 70 - Cover letter and evaluation for Thomas Barr

10/16/2017 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 21012
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs Drug List ID: 0585196480
and more coverage and star ratings.
Password Date: 10/14/2017
Important Coverage Information

You are now viewing 2018 plan data. View 2017 plan data.
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A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment
will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the
enrollee is not responsible for obtaining (prior) authorization.
Some Dental Coverage Some Vision Coverage Some Hearing Coverage
* Estimated

Johns Hopkins Advantage P.O. Box 3538 Overall Star Rating: [?] Enroll
Scranton, PA 18505
MD (PPO)
(H3890-001-0) Members: 2.5 out of 5 stars
1-877-293-5325
Organization: Johns Hopkins 711 (TTY/TDD)
HealthCare
Non Members:
Plan Type: 1-888-403-7682
711 (TTY/TDD)

Fixed Costs

Monthly Drug Plan Premium [?] $41.30

Monthly Health Plan Premium [?] $5.70
Annual Drug Deductible [?] $0.00

Medicare costs at a glance

Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs

Full Year Cost (based on January enrollment) [?]
Broadneck Pharmacy $512.16
CVS Pharmacy # $512.16
Mail Order Pharmacy $503.84
Lower your drug costs

https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=H3890&plnid=001&sgmntid=0 1/3