Page 11 - Cover Letter and Medicare Evaluation for Vic Bosiger

Optima AARP Medicare HumanaChoice
Medicare Value Advantage H5216-248

(HMO) Plan 1 (HMO- (PPO)

$0.00 POS) $0.00

Medicare Advantage and $0.00 Medicare Advantage and
drug monthly premium Medicare Advantage and drug monthly premium

drug monthly premium
Skilled nursing $0 per day for days 1 In-network: $0 per day In-network: $0 per day
facility through 20 for days 1 through 20 for days 1 through 20

$188 per day for days $188 per day for days $188 per day for days

21 through 100 21 through 52 21 through 52
$0 per day for days 53 $0 per day for days 53
through 100 through 100
Out-of-network: Not Out-of-network: 40%
Applicable per stay

Durable medical 20% coinsurance per In-network: 20% In-network: 20%
equipment (like item coinsurance per item coinsurance per item
wheelchairs &
oxygen) Out-of-network: 40%
coinsurance per item

Diabetes supplies $0 copay In-network: $0 copay In-network: $0 copay or
per item 10-20% coinsurance
per item

Out-of-network: 40%
coinsurance per item

Drug coverage & costs

Drugs covered/Not 2 of 2 2 of 2 2 of 2
covered Prescription drugs Prescription drugs Prescription drugs

covered covered covered

Estimated total drug CVS PHARMACY CVS PHARMACY CVS PHARMACY
+ premium cost #07948 #07948 #07948

Standard in- Standard in- Preferred in-
network network network
$2,420.78 $2,487.00 $2,643.18