Page 85 - Cover letter and evaluation for Michele Buros

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UPMC for Life HMO Premier Rx (HMO) (H3907-046-0)
Organization: UPMC Health Plan
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $3,650 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 for Most 4 out of 5
Status: Health: $0.00 Health Plan Services Drug Restrictions: stars
Preferred Cost- Deductible: $0 No
Sharing Part B Drug Copay/ Out of Pocket Lower Your Drug
Premium Coinsurance: Spending Limit: Costs
Cost as of Today: Reduction $0 - $42, 33% $6,700 In-
$0 :No - 45% network MTM Program :
Yes
Mail Order
Cost as of Today:
$82
Advantra Choice Plan (HMO) (H3959-043-0)

Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $3,790 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 for Most 4 out of 5
Status: Health: $0.00 Health Plan Services Drug Restrictions: stars
Preferred Cost- Deductible: Yes
Sharing Part B $995 In- Out of Pocket Lower Your Drug
Premium network Spending Limit: Costs
Cost as of Today: Reduction Drug Copay/ $6,700 In-
$0 :No Coinsurance: network MTM Program :
$0 - $100, Yes
Mail Order 33%
Cost as of Today:
$0
Advantra Silver (HMO) (H3959-010-0)
Organization: HealthAmerica Pennsylvania
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $3,520 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 for Most 4 out of 5
Status: Health: $0.00 Health Plan Services Drug Restrictions: stars
Preferred Cost- Deductible: $0 Yes
Sharing Part B Drug Copay/ Out of Pocket Lower Your Drug
Premium Coinsurance: Spending Limit: Costs
Cost as of Today: Reduction $0 - $100, $6,700 In-
$0 :No 33% network MTM Program :
Yes
Mail Order
Cost as of Today:
$0
Community Blue Medicare HMO Signature (HMO) (H3957-038-0)
Organization: Highmark Choice Company
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]

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