Page 36 - Cover Letter & Evaluation for Patricia Letizia

10/11/2018 Your Plan Results
Health Alliance Medicare POS Basic Rx (HMO-POS) (H1463-015-0)
Organization: Health Alliance 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 $51.00 Annual Drug Doctor All Your Drugs on $4,380 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: Doctors Only 4 out of 5
Status: $20.60 Health Plan (some Drug Restrictions: stars
Standard Cost- Health: Deductible: $0 exceptions) Yes
Sharing $30.40 Drug Copay/ Lower Your
Coinsurance: Out of Pocket Drug Costs
Annual: $640 Part B $0 - $47, 33% Spending
Premium - 50% Limit: MTM Program :
Mail Order Reduction $10,000 In Yes
Annual: $456 :No and Out-of-
network
$6,700 In-
network

Health Alliance Medicare HMO 40 Rx (HMO) (H1463-010-0)
Organization: Health Alliance 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 $71.00 Annual Drug Doctor All Your Drugs on $4,350 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: Doctors for 4 out of 5
Status: $24.60 Health Plan Most Services Drug Restrictions: stars
Standard Cost- Health: Deductible: $0 Yes
Sharing $46.40 Drug Copay/ Out of Pocket Lower Your
Coinsurance: Spending Drug Costs
Annual: $688 Part B $0 - $47, 33% Limit: $4,700
Premium - 50% In-network MTM Program :
Mail Order Reduction Yes
Annual: $504 :No
Health Alliance Medicare HMO Basic Rx (HMO) (H1463-009-0)
Organization: Health Alliance 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 $32.00 Annual Drug Doctor All Your Drugs on $4,120 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: Doctors for 4 out of 5
Status: $27.90 Health Plan Most Services Drug Restrictions: stars
Standard Cost- Health: Deductible: $0 Yes
Sharing $4.10 Drug Copay/ Out of Pocket Lower Your
Coinsurance: Spending Drug Costs
Annual: $727 Part B $0 - $47, 33% Limit: $6,700
Premium - 50% In-network MTM Program :
Mail Order Reduction Yes
Annual: $544 :No
Health Alliance Medicare POS 30 Rx (HMO-POS) (H1463-017-0)
Organization: Health Alliance 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: [?]

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