Page 33 - Cover Letter & Evaluation for Patricia Letizia

10/11/2018 Your Plan Results
Retail $0.00 Annual Drug Doctor All Your Drugs on $3,570 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $0.00 Doctors for 3 out of 5
Status: Health: Health Plan Most Services Drug Restrictions: stars
Standard Cost- $0.00 Deductible: $0 No
Sharing Drug Copay/ Out of Pocket Lower Your
Part B Coinsurance: Spending Drug Costs
Annual: $98 Premium $0 - $100, 33% Limit: $4,000
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $120
Advantra Value (PPO) (H7301-007-0)
Organization: Aetna Medicare
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $3,470 Enrollment begins
Deductible: $0 Choice: Any Formulary :Yes October 15, 2018
Pharmacy Drug: $0.00 Doctor 4 out of 5
Status: Health: Health Plan Drug Restrictions: stars
Standard Cost- $0.00 Deductible: $0 Out of Pocket Yes
Sharing Drug Copay/ Spending Lower Your
Part B Coinsurance: Limit: $6,000 Drug Costs
Annual: $238 Premium $3 - $100, 33% In and Out-
Reduction of-network MTM Program :
Mail Order :No $4,650 In- Yes
Annual: $0 network

Total Care (HMO) (H2663-017-0)
Organization: Coventry Health Care
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $3,260 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $0.00 Doctors for 4 out of 5
Status: Health: Health Plan Most Services Drug Restrictions: stars
Standard Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your
Part B Coinsurance: Spending Drug Costs
Annual: $238 Premium $3 - $100, 33% Limit: $3,500
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $0
HealthPartners UnityPoint Health Align (PPO) (H3416-001-4)
Organization: HealthPartners UnityPoint Health
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $3,590 Not enough Enrollment begins
Deductible: Choice: Any Formulary :Yes data October 15, 2018
Pharmacy Drug: $0.00 $200 Doctor available
Status: Health: Drug Restrictions:
Standard Cost- $0.00 Health Plan Out of Pocket Yes
Sharing Deductible: $0 Spending Lower Your
Part B Drug Copay/ Limit: Drug Costs
Annual: $276 Premium Coinsurance: $10,000 In
Reduction $2 - $100, 29% and Out-of- MTM Program :
Mail Order :No network Yes
Annual: $192 $4,100 In-
network

WellCare Value (HMO-POS) (H1416-009-0)
Organization: WellCare

https://www.medicare.gov/find-a-plan/results/planresults/plan-list.aspx 2/8