Page 43 - Cover Letter and Evaluation for Amy Prack

Retail $155.00 Annual Drug Doctor All Your Drugs on $5,640 Enroll
Deductible: $100 Choice: Formulary: Yes 4 out of 5
Pharmacy Drug: $54.70 Any Doctor stars
Status: Health: Health Plan Drug Restrictions:
Preferred $100.30 Deductible: $225 Out of Yes
Cost-Sharing annual deductible Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Cost as of Premium Coinsurance: $1 - Limit:
Today: $843 Reduction: $97, 31% $3,400 In MTM Program : Yes
No and Out-of-
Mail Order network
Cost as of $3,400 In-
Today: $876 network

HumanaChoice R5495-002 (Regional PPO) (R5495-002-0)
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 $100.00 Annual Drug Doctor All Your Drugs on $5,590 3.5 out of Enroll
Deductible: $395 Choice: Formulary: Yes
Pharmacy Drug: $26.40 Any Doctor 5 stars
Status: Health: Health Plan Drug Restrictions:
Preferred $73.60 Deductible: $1,850 Out of Yes
Cost-Sharing annual deductible Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Cost as of Premium Coinsurance: $9 - Limit:
Today: $848 Reduction: $100, 25% $10,000 In MTM Program : Yes
No and Out-of-
Mail Order network
Cost as of $6,700 In-
Today: $912 network

Aetna Medicare Choice Plan (PPO) (H5521-134-0)
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: [?] [?]
Retail $98.00 Annual Drug Doctor All Your Drugs on $5,550 Enroll
Deductible: $0 Choice: Formulary: Yes 4 out of 5
Pharmacy Drug: $16.60 Any Doctor stars
Status: Health: Health Plan Drug Restrictions:
Preferred $81.40 Deductible: $1,000 Out of Yes
Cost-Sharing annual deductible Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Cost as of Premium Coinsurance: $2 - Limit:
Today: $851 Reduction: $100, 33% $7,500 In MTM Program : Yes
No and Out-of-
Mail Order network
Cost as of $4,100 In-
Today: $1,038 network

CareSource Advantage Plus (HMO) (H6396-002-0)
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: [?] [?]