Page 42 - Cover Letter and Evaluation for Amy Prack

Retail $103.00 Annual Drug Doctor All Your Drugs on $5,420 Enroll
Deductible: $225 Choice: Formulary: Yes 3.5 out of
Pharmacy Drug: $36.40 Plan 5 stars
Status: Health: Health Plan Doctors for Drug Restrictions:
Preferred $66.60 Deductible: $1,850 Most Yes
Cost-Sharing Out-of-network Services Lower Your Drug
Part B Drug Copay/ Costs
Cost as of Premium Coinsurance: $7 - Out of
Today: $806 Reduction: $100, 28% Pocket MTM Program : Yes
No Spending
Mail Order Limit:
Cost as of $6,700 In
Today: $873 and Out-of-
network

CareSource Advantage Zero Premium (HMO) (H6396-004-0)
Organization: CareSource
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 $5,010 Enroll
Deductible: $250 Choice: Formulary: Yes 2.5 out of
Pharmacy Drug: $0.00 Plan 5 stars
Status: Health: $0.00 Health Plan Doctors for Drug Restrictions:
Standard Deductible: $0 In- Most Yes
Cost-Sharing Part B network Services Lower Your Drug
Premium Drug Copay/ Costs
Cost as of Reduction: Coinsurance: $6 - Out of
Today: $820 No $100, 28% Pocket MTM Program : Yes
Spending
Mail Order Limit:
Cost as of $6,700 In-
Today: $897 network

MediGold Classic Preferred (HMO) (H3668-018-1)
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: [?] [?]
Retail $120.00 Annual Drug Doctor All Your Drugs on $5,130 4 out of 5 Enroll
Deductible: $0 Choice: Formulary: Yes
Pharmacy Drug: $43.80 Plan stars
Status: Health: Health Plan Doctors for Drug Restrictions:
Standard $76.20 Deductible: $0 Most Yes
Cost-Sharing Drug Copay/ Services Lower Your Drug
Part B Coinsurance: $0 - Costs
Cost as of Premium $75, 33% Out of
Today: $832 Reduction: Pocket MTM Program : Yes
No Spending
Mail Order Limit:
Cost as of $3,900 In-
Today: $757 network

HumanaChoice H5525-030 (PPO) (H5525-030-0)
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: [?] [?]