Page 90 - Cover letter and evaluation for Michele Buros

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Retail $84.00 Annual Drug Doctor Choice: All Your Drugs on $4,010 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $30.10 for Most 4.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Standard Cost- $53.90 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: Spending Limit: Costs
Cost as of Today: Premium $3 - $95, 33% $3,900 In-
$350 Reduction network MTM Program :
:No Yes
Mail Order
Cost as of Today:
$301
UPMC for Life PPO High Deductible with Rx (PPO) (H5533-003-0)
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 $35.00 Annual Drug Doctor Choice: All Your Drugs on $4,150 Enroll
Deductible: $0 Any Doctor Formulary :Yes
Pharmacy Drug: $35.00 4 out of 5
Status: Health: $0.00 Health Plan Out of Pocket Drug Restrictions: stars
Preferred Cost- Deductible: Spending Limit: No
Sharing Part B $1,250 annual $10,000 In and Lower Your Drug
Premium deductible Out-of-network Costs
Cost as of Today: Reduction Drug Copay/ $6,700 In-
$350 :No Coinsurance: network MTM Program :
$0 - $95, 33% Yes
Mail Order
Cost as of Today:
$432
Aetna Medicare Silver Plan (HMO) (H3931-070-0)
Organization: Aetna Medicare
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 $56.00 Annual Drug Doctor Choice: All Your Drugs on $4,130 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $36.20 for Most 3.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Preferred Cost- $19.80 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: Spending Limit: Costs
Cost as of Today: Premium $0 - $100, $6,700 In-
$362 Reduction 33% network MTM Program :
:No Yes
Mail Order
Cost as of Today:
$362
HumanaChoice R0923-002 (Regional PPO) (R0923-002-0)
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: [?]
Retail $95.00 Annual Drug Doctor Choice: All Your Drugs on $4,770 Enroll
Deductible: Any Doctor Formulary :Yes
Pharmacy Drug: $29.40 $315 3.5 out of 5
Status: Health: Out of Pocket Drug Restrictions: stars
Preferred Cost- $65.60 Health Plan Spending Limit: Yes
Sharing Deductible: $10,000 In and Lower Your Drug
Part B $500 annual Out-of-network Costs
Cost as of Today: Premium deductible $6,700 In-
$371 Reduction Drug Copay/ network MTM Program :
:No Coinsurance: Yes
Mail Order $10 - $99,
Cost as of Today: 26%
$294
UPMC for Life HMO Rx (HMO) (H3907-029-0)
Organization: UPMC Health Plan

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