Page 87 - Cover letter and evaluation for Michele Buros

Your Plan Results https://www.medicare.gov/find-a-plan/results/planresults/plan-list.aspx

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 $20.00 Annual Drug Doctor Choice: All Your Drugs on $3,640 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $20.00 for Most 4 out of 5
Status: Health: $0.00 Health Plan Services Drug Restrictions: stars
Preferred Cost- Deductible: No
Sharing Part B $750 In- Out of Pocket Lower Your Drug
Premium network Spending Limit: Costs
Cost as of Today: Reduction Drug Copay/ $4,000 In-
$200 :No Coinsurance: network MTM Program :
$0 - $95, 33% Yes
Mail Order
Cost as of Today:
$282
AdvantraOne (PPO) (H5522-017-0)
Organization: HealthAmerica
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 $19.00 Annual Drug Doctor Choice: All Your Drugs on $3,310 Enroll
Deductible: Any Doctor Formulary :Yes
Pharmacy Drug: $19.00 $195 4 out of 5
Status: Health: $0.00 Out of Pocket Drug Restrictions: stars
Preferred Cost- Health Plan Spending Limit: Yes
Sharing Part B Deductible: $10,000 In and Lower Your Drug
Premium $1,600 annual Out-of-network Costs
Cost as of Today: Reduction deductible $6,700 In-
$217 :Yes Drug Copay/ network MTM Program :
Coinsurance: Yes
Mail Order $2 - $100,
Cost as of Today: 29%
$190
Advantra Silver (PPO) (H5522-018-0)
Organization: HealthAmerica
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 $36.00 Annual Drug Doctor Choice: All Your Drugs on $3,830 Enroll
Deductible: $0 Any Doctor Formulary :Yes
Pharmacy Drug: $22.00 4 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Preferred Cost- $14.00 Deductible: Spending Limit: Yes
Sharing $1,000 annual $10,000 In and Lower Your Drug
Part B deductible Out-of-network Costs
Cost as of Today: Premium Drug Copay/ $6,700 In-
$220 Reduction Coinsurance: network MTM Program :
:No $0 - $100, Yes
Mail Order 33%
Cost as of Today:
$220
Humana Value Plus H5216-117 (PPO) (H5216-117-0)
Organization: Humana Insurance 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: [?]

4 of 10 02/21/18, 5:04 PM