Page 40 - Cover Letter and Evaluation for Amy Prack

Retail $0.00 Annual Drug Doctor All Your Drugs on $4,550 Enroll
Deductible: $150 Choice: Formulary: Yes 4 out of 5
Pharmacy Drug: $0.00 Plan stars
Status: Health: $0.00 Health Plan Doctors for Drug Restrictions:
Standard Deductible: $0 Most Yes
Cost-Sharing Part B Drug Copay/ Services Lower Your Drug
Premium Coinsurance: $2 - Costs
Cost as of Reduction: $95, 30% Out of
Today: $746 No Pocket MTM Program : Yes
Spending
Mail Order Limit:
Cost as of $4,900 In-
Today: $741 network

Anthem MediBlue Essential (HMO) (H3655-032-0)
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 $4,430 3.5 out of Enroll
Deductible: $60 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, 31% Out of
Today: $760 No Pocket MTM Program : Yes
Spending
Mail Order Limit:
Cost as of $4,900 In-
Today: $630 network

MedMutual Advantage Premium (PPO) (H4497-003-1)
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 $119.00 Annual Drug Doctor All Your Drugs on $5,080 Enroll
Deductible: $55 Choice: Formulary: Yes 3.5 out of
Pharmacy Drug: $59.70 Any Doctor 5 stars
Status: Health: Health Plan Drug Restrictions:
Preferred $59.30 Deductible: $1,250 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: $767 Reduction: $42, 32% - 50% $5,100 In MTM Program : Yes
No and Out-of-
Mail Order network
Cost as of $3,400 In-
Today: $803 network

Aetna Medicare Value Plan (PPO) (H5521-089-0)
Organization: Aetna Medicare
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: [?] [?]