Page 92 - Cover letter and evaluation for Michele Buros

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Retail $79.00 Annual Drug Doctor Choice: All Your Drugs on $4,360 Enroll
Deductible: $0 Any Doctor Formulary :Yes
Pharmacy Drug: $72.50 4 out of 5
Status: Health: $6.50 Health Plan Out of Pocket Drug Restrictions: stars
Preferred Cost- Deductible: $0 Spending Limit: No
Sharing Part B Drug Copay/ $10,000 In and Lower Your Drug
Premium Coinsurance: Out-of-network Costs
Cost as of Today: Reduction $0 - $90, 33% $6,700 In-
$725 :No network MTM Program :
Yes
Mail Order
Cost as of Today:
$725
UPMC for Life HMO Rx Enhanced (HMO) (H3907-006-0)
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 $263.00 Annual Drug Doctor Choice: All Your Drugs on $5,880 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $72.90 for Most 4 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Preferred Cost- $190.10 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-
$729 Reduction network MTM Program :
:No Yes
Mail Order
Cost as of Today:
$811
Freedom Blue PPO Select (PPO) (H3916-022-0)
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: [?]
Retail $174.00 Annual Drug Doctor Choice: All Your Drugs on $5,240 Enroll
Deductible: $0 Any Doctor Formulary :Yes
Pharmacy Drug: $89.20 4 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Preferred Cost- $84.80 Deductible: $0 Spending Limit: No
Sharing Drug Copay/ $10,000 In and Lower Your Drug
Part B Coinsurance: Out-of-network Costs
Cost as of Today: Premium $0 - $90, 33% $6,700 In-
$892 Reduction network MTM Program :
:No Yes
Mail Order
Cost as of Today:
$892
Security Blue HMO Standard (HMO) (H3957-003-0)
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 $203.50 Annual Drug Doctor Choice: All Your Drugs on $5,410 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $98.00 for Most 4 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Standard Cost- $105.50 Deductible: $0 No
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-
$980 Reduction 33% network MTM Program :
:No Yes
Mail Order
Cost as of Today:
$980
Freedom Blue PPO Classic (PPO) (H3916-001-0)
Organization: Highmark Senior Health Company

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