Page 38 - Cover Letter and Evaluation for Amy Prack

Retail $38.00 Annual Drug Doctor All Your Drugs on $4,200 Enroll
Deductible: $55 Choice: Formulary: Yes 3.5 out of
Pharmacy Drug: $37.50 Plan 5 stars
Status: Health: $0.50 Health Plan Doctors for Drug Restrictions:
Preferred Deductible: $0 Most Yes
Cost-Sharing Part B Drug Copay/ Services Lower Your Drug
Premium Coinsurance: $0 - Costs
Cost as of Reduction: $42, 32% - 50% Out of
Today: $612 No Pocket MTM Program : Yes
Spending
Mail Order Limit:
Cost as of $3,950 In-
Today: $648 network

HumanaChoice H5216-045 (PPO) (H5216-045-0)
Organization: Humana
Estimated Monthly Deductibles [?] Health Drug Coverage [?] Estimated Overall
Annual Drug Premium: and Drug Copay Benefits: , Drug Restrictions Annual Health Star
Costs: [?] [?] [?] / Coinsurance: [?] [?] and Other and Drug Rating:
[?] Programs: Costs: [?] [?]
Retail $65.00 Annual Drug Doctor All Your Drugs on $4,650 4 out of 5 Enroll
Deductible: $100 Choice: Formulary: Yes
Pharmacy Drug: $21.70 Any Doctor stars
Status: Health: Health Plan Drug Restrictions:
Preferred $43.30 Deductible: $0 Out of Yes
Cost-Sharing Drug Copay/ Pocket Lower Your Drug
Part B Coinsurance: $7 - Spending Costs
Cost as of Premium $97, 31% Limit:
Today: $625 Reduction: $10,000 In MTM Program : Yes
No and Out-of-
Mail Order network
Cost as of $4,900 In-
Today: $645 network

MedMutual Advantage Select (PPO) (H4497-001-1)
Organization: Medical Mutual of Ohio
Estimated Monthly Deductibles [?] Health Drug Coverage [?] Estimated Overall
Annual Drug Premium: and Drug Copay Benefits: , Drug Restrictions Annual Health Star
Costs: [?] [?] [?] / Coinsurance: [?] [?] and Other and Drug Rating:
[?] Programs: Costs: [?] [?]
Retail $38.00 Annual Drug Doctor All Your Drugs on $4,500 Enroll
Deductible: $160 Choice: Formulary: Yes 3.5 out of
Pharmacy Drug: $38.00 Any Doctor 5 stars
Status: Health: $0.00 Health Plan Drug Restrictions:
Preferred Deductible: $2,000 Out of Yes
Cost-Sharing Part B annual deductible Pocket Lower Your Drug
Premium Drug Copay/ Spending Costs
Cost as of Reduction: Coinsurance: $0 - Limit:
Today: $678 No $42, 30% - 50% $10,000 In MTM Program : Yes
and Out-of-
Mail Order network
Cost as of $6,500 In-
Today: $756 network

Humana Gold Plus H6622-019 (HMO) (H6622-019-0)
Organization: Humana
Estimated Monthly Deductibles [?] Health Drug Coverage [?] Estimated Overall
Annual Drug Premium: and Drug Copay Benefits: , Drug Restrictions Annual Health Star
Costs: [?] [?] [?] / Coinsurance: [?] [?] and Other and Drug Rating:
[?] Programs: Costs: [?] [?]