Page 64 - Cover Letter & Evaluation for Michael Novotny

6/9/2018 Your Plan Results
Central Health Medicare Plan (HMO) (H5649-001-0)
Organization: Central Health Medicare Plan
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 $1,910 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 - $75, 33% Limit: $3,400 Yes
Reduction In-network
:No

Health Net Gold Select (HMO) (H0562-101-1)
Organization: Health Net 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 $2,050 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 - $90, 33% Limit: $2,000 Yes
Reduction In-network
:No

Golden State Medicare Gold (HMO) (H2241-007-1)
Organization: Golden State
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 $1,910 Enroll
Annual: $0.00 Deductible: $0 Choice: Plan Formulary :N/A
Drug: $0.00 Doctors for 3 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 $5 - $95, 33% Limit: $3,400 Yes
Reduction In-network
:No

Humana Value Plus H5619-037 (HMO) (H5619-037-0)
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 $16.30 Annual Drug Doctor All Your Drugs on $2,980 Enroll
Annual: Deductible: Choice: Plan Formulary :N/A
$195.60 Drug: $405 Doctors for 4 out of 5
$16.30 Most Services Drug Restrictions: stars
Mail Order Health: Health Plan N/A
Annual: N/A $0.00 Deductible: Out of Pocket MTM Program :
$183 In-
Spending
Part B network Limit: $6,700 Yes
Premium Drug Copay/ In-network
Reduction Coinsurance:
:No $0 - $100, 25%
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