Page 45 - Cover Letter and Evaluation for Amy Prack

Retail $120.00 Annual Drug Doctor All Your Drugs on $5,950 Enroll
Deductible: $0 Choice: Formulary: Yes 4 out of 5
Pharmacy Drug: $36.50 Any Doctor stars
Status: Health: Health Plan Drug Restrictions:
Preferred $83.50 Deductible: $1,500 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: $990 Reduction: $100, 33% $10,000 In MTM Program : Yes
No and Out-of-
Mail Order network
Cost as of $4,750 In-
Today: $1,177 network

Aetna Medicare OH Connect Gold 2 (Regional PPO) (R6694-005-0)
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 $190.00 Annual Drug Doctor All Your Drugs on $6,700 4 out of 5 Enroll
Deductible: $350 Choice: Formulary: Yes
Pharmacy Drug: $21.50 Any Doctor stars
Status: Health: Health Plan Drug Restrictions:
Preferred $168.50 Deductible: $250 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: $1,026 Reduction: $100, 26% $7,500 In MTM Program : Yes
No and Out-of-
Mail Order network
Cost as of $3,500 In-
Today: $1,211 network

Anthem MediBlue Extra (HMO) (H3655-041-0)
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 $32.90 Annual Drug Doctor All Your Drugs on $4,590 Enroll
Deductible: $415 Choice: Formulary: Yes 3.5 out of
Pharmacy Drug: $32.90 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, 25% Out of
Today: $1,031 No Pocket MTM Program : Yes
Spending
Mail Order Limit:
Cost as of $6,700 In-
Today: $1,215 network

Aetna Medicare OH Connect Gold (Regional PPO) (R6694-003-0)
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: [?] [?]