Page 62 - Cover Letter & Evaluation for Michael Novotny

6/9/2018 Your Plan Results
Blue Shield 65 Plus (HMO) (H0504-015-0)
Organization: Blue Shield of California
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 3.5 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, 30% Limit: $2,800 Yes
Reduction - 33% In-network
:No

Aetna Medicare Prime Plan (HMO) (H0523-060-0)
Organization: Aetna Medicare
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 $2,330 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 3.5 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 - $100, 33% Limit: $1,950 Yes
Reduction In-network
:No

Blue Shield 65 Plus Choice Plan (HMO) (H0504-021-0)
Organization: Blue Shield of California
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 $2,100 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 3.5 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 $3 - $95, 31% Limit: $2,400 Yes
Reduction - 33% In-network
:No

Aetna Medicare Select Plan (HMO) (H0523-002-0)
Organization: Aetna Medicare
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 $2,920 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 3.5 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 - $100, 33% Limit: $4,600 Yes
Reduction In-network
:No

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