Page 39 - Cover Letter and Evaluation for Amy Prack

Retail $87.00 Annual Drug Doctor All Your Drugs on $4,640 Enroll
Deductible: $125 Choice: Formulary: Yes 4 out of 5
Pharmacy Drug: $30.80 Plan stars
Status: Health: Health Plan Doctors for Drug Restrictions:
Preferred $56.20 Deductible: $100 In- Most Yes
Cost-Sharing network Services Lower Your Drug
Part B Drug Copay/ Costs
Cost as of Premium Coinsurance: $1 - Out of
Today: $680 Reduction: $97, 30% Pocket MTM Program : Yes
No Spending
Mail Order Limit:
Cost as of $3,900 In-
Today: $734 network

Anthem MediBlue Preferred (HMO) (H3655-040-0)
Organization: Anthem Blue Cross and Blue Shield
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 $0.00 Annual Drug Doctor All Your Drugs on $4,290 3.5 out of Enroll
Deductible: $0 Choice: Formulary: Yes
Pharmacy Drug: $0.00 Plan 5 stars
Status: Health: $0.00 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: $95, 33% Out of
Today: $715 No Pocket MTM Program : Yes
Spending
Mail Order Limit:
Cost as of $4,900 In-
Today: $570 network

MedMutual Advantage Preferred (PPO) (H4497-002-1)
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 $74.00 Annual Drug Doctor All Your Drugs on $4,780 Enroll
Deductible: $55 Choice: Formulary: Yes 3.5 out of
Pharmacy Drug: $56.00 Any Doctor 5 stars
Status: Health: Health Plan Drug Restrictions:
Preferred $18.00 Deductible: $1,750 Out of Yes
Cost-Sharing annual deductible Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Cost as of Premium Coinsurance: $0 - Limit:
Today: $741 Reduction: $42, 32% - 50% $10,000 In MTM Program : Yes
No and Out-of-
Mail Order network
Cost as of $5,700 In-
Today: $777 network

MediGold Essential Care (HMO) (H3668-019-1)
Organization: MediGold
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: [?] [?]