Page 35 - Cover Letter & Evaluation for Patricia Letizia

10/11/2018 Your Plan Results
Retail $15.90 Annual Drug Doctor All Your Drugs on $3,640 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $415 Doctors for 3 out of 5
Status: $15.90 Most Services Drug Restrictions: stars
Standard Cost- Health: Health Plan Yes
Sharing $0.00 Deductible: Out of Pocket Lower Your
$147 In- Spending Drug Costs
Annual: $438 Part B network Limit: $6,700
Premium Drug Copay/ In-network MTM Program :
Mail Order Reduction Coinsurance: Yes
Annual: $390 :No $0 - $47, 25%
- 50%
Humana Gold Plus H1468-007 (HMO) (H1468-007-0)
Organization: Humana
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 $3,330 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $0.00 $200 Doctors for 4.5 out of 5
Status: Health: Most Services Drug Restrictions: stars
Preferred Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your
Part B Drug Copay/ Spending Drug Costs
Annual: $474 Premium Coinsurance: Limit: $4,500
Reduction $6 - $100, 29% In-network MTM Program :
Mail Order :No Yes
Annual: $0
Advantra Complete (PPO) (H7301-009-0)
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 $26.00 Annual Drug Doctor All Your Drugs on $3,540 Enrollment begins
Deductible: $0 Choice: Any Formulary :Yes October 15, 2018
Pharmacy Drug: Doctor 4 out of 5
Status: $20.20 Health Plan Drug Restrictions: stars
Standard Cost- Health: Deductible: $0 Out of Pocket Yes
Sharing $5.80 Drug Copay/ Spending Lower Your
Coinsurance: Limit: Drug Costs
Annual: $480 Part B $3 - $100, 33% $10,000 In
Premium and Out-of- MTM Program :
Mail Order Reduction network Yes This is the plan you
Annual: $242 :No $5,500 In-
network are currently
enrolled in.

HumanaChoice H5525-004 (PPO) (H5525-004-0)
Organization: Humana
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 $97.00 Annual Drug Doctor All Your Drugs on $4,710 Enrollment begins
Deductible: Choice: Any Formulary :Yes October 15, 2018
Pharmacy Drug: $250 Doctor 4 out of 5
Status: $11.40 Drug Restrictions: stars
Preferred Cost- Health: Health Plan Out of Pocket Yes
Sharing $85.60 Deductible: $0 Spending Lower Your
Drug Copay/ Limit: $8,250 Drug Costs
Annual: $611 Part B Coinsurance: In and Out-
Premium $6 - $100, 28% of-network MTM Program :
Mail Order Reduction $5,500 In- Yes
Annual: $137 :No network

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