Page 68 - Cover Letter & Evaluation for Michael Novotny

6/9/2018 Your Plan Results
Inter Valley Health Plan Value Preferred Choice (HMO) (H0545-
014-0)
Organization: Inter Valley Health 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 $35.50 Annual Drug Doctor All Your Drugs on $3,580 Enroll
Annual: Deductible: Choice: Plan Formulary :N/A
$426.00 Drug: $405 Doctors for 3.5 out of 5
$35.50 Most Services Drug Restrictions: stars
Mail Order Health: Health Plan N/A
Annual: N/A $0.00 Deductible: $0 Out of Pocket
Drug Copay/ Spending MTM Program :
Part B Coinsurance: Limit: $5,900 Yes
Premium 25% In-network
Reduction
:No
Brand New Day Classic Choice for Medi-Medi (HMO) (H0838-033-0)
Organization: Brand New Day
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 $35.50 Annual Drug Doctor All Your Drugs on $3,530 Enroll
Annual: Deductible: Choice: Plan Formulary :N/A
$426.00 Drug: $405 Doctors for 3.5 out of 5
$35.50 Most Services Drug Restrictions: stars
Mail Order Health: Health Plan N/A
Annual: N/A $0.00 Deductible: $0 Out of Pocket
Spending
Drug Copay/ MTM Program :
Part B Coinsurance: Limit: $6,700 Yes
Premium 0% - 25% In-network
Reduction
:No
Coordinated Choice Plan (HMO) (H5928-037-0)
Organization: Care1st Health 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 $35.50 Annual Drug Doctor All Your Drugs on $3,170 Enroll
Annual: Deductible: Choice: Plan Formulary :N/A
$426.00 Drug: $405 Doctors for 3.5 out of 5
$35.50 Most Services Drug Restrictions: stars
Mail Order Health: Health Plan N/A
Annual: N/A $0.00 Deductible: $0 Out of Pocket
Spending
Drug Copay/ MTM Program :
Part B Coinsurance: Limit: $6,700 Yes
Premium $0, 25% In-network
Reduction
:No
Aetna Medicare Choice Plan (PPO) (H5521-056-0)
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: [?]

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