Page 68 - Cover Letter and Evaluation for Barbara Lesswing

11/20/2017 Your Medicare Health Plan Comparison

Costs shown below are total costs,
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including premiums, deductible, and co-
Your Plan Comparison payments.
Zip Code: 14031
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs
and coverage and star ratings. Drug List ID: 1026286272
Password Date: 11/18/2017
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 Nationwide Coverage Some Hearing Coverage
* Estimated

Your current plan

Independent Health Encompass 65 Basic (HMO) Aetna Medicare Rx Saver (PDP)
(H3362-017) Plan Type: (S5810-037) Plan Type:
Organization: Independent Health Organization: Aetna Medicare
Members: 1-800-665-1502 Members: 1-877-238-6211
1-800-432-1110(TTY/TDD) 711(TTY/TDD)
Non Members: 1-800-958-4405 Non Members: 1-855-338-7030
1-888-357-9167(TTY/TDD) 711(TTY/TDD)
Coverage: Provides health and drug coverage Coverage: Provides drug coverage only.
NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs

Monthly Drug Plan Premium $86.30 Monthly Drug Plan Premium $38.60
Monthly Health Plan Premium $31.70 Monthly Health Plan Premium N/A

Annual Drug Deductible $0.00 Annual Drug Deductible $300.00
Medicare costs at a glance Medicare costs at a glance

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

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