Page 73 - Cover Letter & Evaluation for Isaac Kapon

10/4/2017 Your Plan Results
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 $46.00 Annual Drug Doctor Choice: All Your Drugs on $5,470 Coming Soon Enrollment begins
Annual: Deductible: $75 Any Doctor Formulary :No October 15, 2017
Drug: $46.00
Mail Order Health: Health Plan Out of Pocket Drug Restrictions:
Annual: N/A $0.00 Deductible: Spending No
Limit: $10,000
$750 annual
Part B deductible In and Out-of- Lower Your Drug
Costs
Premium Drug Copay/ network
Reduction Coinsurance: $3 $6,700 In- MTM Program :
:No - $100, 31% network Yes

Aetna Medicare Select Plan (PPO) (H5521-022-0)
Organization: Aetna Medicare
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 $96.00 Annual Drug Doctor Choice: All Your Drugs on $5,720 Coming Soon Enrollment begins
Annual: Deductible: $0 Any Doctor Formulary :No October 15, 2017
Drug: $52.30
Mail Order Health: Health Plan Out of Pocket Drug Restrictions:
Annual: N/A $43.70 Deductible: Spending No
$750 annual
Limit: $8,200
Part B deductible In and Out-of- Lower Your Drug
Costs
Premium Drug Copay/ network
Reduction Coinsurance: $3 $5,000 In- MTM Program :
:No - $100, 33% network Yes

HumanaChoice H5216-036 (PPO) (H5216-036-0)
Organization: Humana Insurance Company
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 $140.00 Annual Drug Doctor Choice: All Your Drugs on $6,020 Coming Soon Enrollment begins
Annual: Deductible: Any Doctor Formulary :No October 15, 2017
Drug: $56.20 $225
Mail Order Health: Out of Pocket Drug Restrictions:
Annual: N/A $83.80 Health Plan Spending No
Deductible:
Limit: $7,500
Part B $1,000 annual In and Out-of- Lower Your Drug
Costs
Premium deductible network
Reduction Drug Copay/ $6,700 In- MTM Program :
:No Coinsurance: $4 network Yes
- $100, 28%

Notes:
Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
Extra Help from Medicare paying your drug costs.

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