Page 56 - Cover Letter and Evaluation for Amy Prack

Return to previous page
Your Plan Details

Zip Code: 43221
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs Drug List ID: 3233662560
and more coverage and star ratings.
Password Date: 05/12/2019
Important Coverage Information

Symbols
A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment
will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the
enrollee is not responsible for obtaining (prior) authorization.
Some Dental Coverage Some Vision Coverage Some Hearing Coverage

* Estimated

Humana Gold Plus H6622- 500 West Main Street Overall Star Rating: Enroll
013 (HMO) Louisville, KY 40202 Members: [?]
1-800-457-4708 711 (TTY/TDD)
(H6622-013-0) Non Members: 1-800-833-2364 4 out of 5 stars
711 (TTY/TDD)
Organization: Humana
Plan Type: HMO

Fixed Costs

Monthly Drug Plan Premium [?] $0.00

Monthly Health Plan Premium [?] $0.00
Annual Drug Deductible [?] $0.00
Medicare costs at a glance

Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs

Cost For Rest of Year (based on enrollment today) [?]
Giant Eagle Pharmacy #6515 $373.17
Mail Order Pharmacy $393.00
Lower your drug costs

Estimated Full Cost the Plan Charges Medicare for Your Drugs
Drug Costs During Coverage Levels