Page 44 - Cover Letter and Evaluation for Amy Prack

Retail $67.00 Annual Drug Doctor All Your Drugs on $5,000 Enroll
Deductible: $0 Choice: Formulary: Yes 2.5 out of
Pharmacy Drug: $32.90 Plan 5 stars
Status: Health: Health Plan Doctors for Drug Restrictions:
Standard $34.10 Deductible: $0 Most Yes
Cost-Sharing Drug Copay/ Services Lower Your Drug
Part B Coinsurance: $0 - Costs
Cost as of Premium $100, 33% Out of
Today: $930 Reduction: Pocket MTM Program : Yes
No Spending
Mail Order Limit:
Cost as of $3,900 In-
Today: $980 network

CareSource Advantage (HMO) (H6396-001-0)
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 $32.90 Annual Drug Doctor All Your Drugs on $4,990 2.5 out of Enroll
Deductible: $0 Choice: Formulary: Yes
Pharmacy Drug: $32.90 Plan 5 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: $4 - Costs
Cost as of Reduction: $100, 33% Out of
Today: $966 No Pocket MTM Program : Yes
Spending
Mail Order Limit:
Cost as of $4,600 In-
Today: $994 network

Anthem MediBlue Access Basic (Regional PPO) (R5941-014-0)
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 $70.00 Annual Drug Doctor All Your Drugs on $5,010 Enroll
Deductible: $200 Choice: Formulary: Yes 3 out of 5
Pharmacy Drug: $57.80 Any Doctor stars
Status: Health: Health Plan Drug Restrictions:
Preferred $12.20 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: $0 - Limit:
Today: $984 Reduction: $42, 29% - 41% $10,000 In MTM Program : Yes
No and Out-of-
Mail Order network
Cost as of $6,000 In-
Today: $1,008 network

Aetna Medicare Standard Plan (PPO) (H5521-020-0)
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: [?] [?]