Page 91 - Cover letter and evaluation for Michele Buros

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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 $81.00 Annual Drug Doctor Choice: All Your Drugs on $4,100 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $61.90 for Most 4 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Preferred Cost- $19.10 Deductible: $0 No
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: Spending Limit: Costs
Cost as of Today: Premium $0 - $95, 33% $3,400 In-
$619 Reduction network MTM Program :
:No Yes
Mail Order
Cost as of Today:
$701
Security Blue HMO ValueRx (HMO) (H3957-031-0)
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: [?]
Retail $67.00 Annual Drug Doctor Choice: All Your Drugs on $4,120 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $66.90 for Most 4 out of 5
Status: Health: $0.10 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 - $90, 33% $6,700 In-
$669 :No network MTM Program :
Yes
Mail Order
Cost as of Today:
$669
UPMC for Life PPO Rx Enhanced (PPO) (H5533-005-0)
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 $135.00 Annual Drug Doctor Choice: All Your Drugs on $4,620 Enroll
Deductible: $0 Any Doctor Formulary :Yes
Pharmacy Drug: $68.70 4 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Preferred Cost- $66.30 Deductible: Spending Limit: No
Sharing $500 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-
$687 Reduction Coinsurance: network MTM Program :
:No $0 - $95, 33% Yes
Mail Order
Cost as of Today:
$769
Freedom Blue PPO ValueRx (PPO) (H3916-032-0)
Organization: Highmark Senior Health 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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