Page 52 - Cover Letter and Evaluation for Debbie Workman

12/13/2017 Your Plan Results
Premera Blue Cross Medicare Advantage (HMO) (H7245-001-0)
Organization: Premera Blue Cross Medicare Advantage
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $3,910 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 $340 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: Premium Coinsurance: $5 Limit: $6,200
Reduction - $42, 26% - In-network MTM Program :
Mail Order :No 35% Yes
Annual: $257
Community HealthFirst MA Extra Plan (HMO) (H5826-010-0)
Organization: Community HealthFirst Medicare Advantage Plan
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $20.90 Annual Drug Doctor Choice: All Your Drugs on $4,180 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $20.90 for Most 3.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Standard Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $2 Spending Costs
Annual: Premium - $47, 25% - Limit: $6,700
Reduction 33% In-network MTM Program :
Mail Order :No Yes
Annual: $413
Premera Blue Cross Medicare Advantage Total Health (HMO)
(H7245-005-0)
Organization: Premera Blue Cross Medicare Advantage
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $24.00 Annual Drug Doctor Choice: All Your Drugs on $3,910 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $20.40 $180 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $3.60 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: Premium Coinsurance: $2 Limit: $5,500
Reduction - $42, 29% - In-network MTM Program :
Mail Order :No 35% Yes
Annual: $430
Kaiser Permanente Medicare Advantage Columbia (HMO) (H5050-
019-0)
Organization: Kaiser Foundation Health Plan of Washington
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $99.00 Annual Drug Doctor Choice: All Your Drugs on $8,490 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $28.40 for Most 4.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Out-of-network $70.60 Deductible: $0 Out of Pocket No
Drug Copay/ Lower Your Drug
Annual: Part B Coinsurance: $0 Spending Costs
Premium - $90, 33% Limit: $4,500
Mail Order Reduction In-network MTM Program :
Annual: $472 :No Yes

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