Page 61 - Cover Letter & Evaluation for Michael Novotny

6/9/2018 Your Plan Results
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $2,280 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 4.5 out of 5
Mail Order Health: Health Plan Most Services Drug Restrictions: stars
Annual: N/A $0.00 Deductible: $0 Out of Pocket N/A
Drug Copay/
Part B Coinsurance: Spending MTM Program :
Premium $0 - $95, 33% Limit: $2,400 Yes
Reduction In-network
:No

AARP MedicareComplete SecureHorizons Plan 2 (HMO) (H0543-
138-0)
Organization: UnitedHealthcare
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $2,460 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 4.5 out of 5
Mail Order Health: Health Plan Most Services Drug Restrictions: stars
Annual: N/A $0.00 Deductible: $0 N/A
Drug Copay/ Out of Pocket
Part B Coinsurance: Spending MTM Program :
Premium $0 - $100, 33% Limit: $2,200 Yes
Reduction In-network
:No

Anthem MediBlue Select (HMO) (H0544-059-0)
Organization: Anthem Blue Cross
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $2,460 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 4.5 out of 5
Mail Order Health: Health Plan Most Services Drug Restrictions: stars
Annual: N/A $0.00 Deductible: $0 N/A
Drug Copay/ Out of Pocket
Part B Coinsurance: Spending MTM Program :
Premium $0 - $95, 33% Limit: $1,900 Yes
Reduction In-network
:No

Humana Gold Plus H5619-021 (HMO) (H5619-021-0)
Organization: Arcadian Health Plan, Inc.
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $2,320 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 4 out of 5
Mail Order Health: Health Plan Most Services Drug Restrictions: stars
Annual: N/A $0.00 Deductible: $0 N/A
Drug Copay/ Out of Pocket
Part B Coinsurance: Spending MTM Program :
Premium $0 - $100, 33% Limit: $2,200 Yes
Reduction In-network
:No

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