Page 37 - Cover Letter & Evaluation for Patricia Letizia

10/11/2018 Your Plan Results
Retail $95.00 Annual Drug Doctor All Your Drugs on $4,710 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: Doctors Only 4 out of 5
Status: $28.10 Health Plan (some Drug Restrictions: stars
Standard Cost- Health: Deductible: $0 exceptions) Yes
Sharing $66.90 Drug Copay/ Lower Your
Coinsurance: Out of Pocket Drug Costs
Annual: $730 Part B $0 - $47, 33% Spending
Premium - 50% Limit: MTM Program :
Mail Order Reduction $10,000 In Yes
Annual: $546 :No and Out-of-
network
$5,500 In-
network

HumanaChoice R5361-002 (Regional PPO) (R5361-002-0)
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 $117.00 Annual Drug Doctor All Your Drugs on $5,470 Enrollment begins
Deductible: Choice: Any Formulary :Yes October 15, 2018
Pharmacy Drug: $390 Doctor 3.5 out of 5
Status: $27.80 Drug Restrictions: stars
Preferred Cost- Health: Health Plan Out of Pocket Yes
Sharing $89.20 Deductible: Spending Lower Your
$183 annual Limit: Drug Costs
Annual: $736 Part B deductible $10,000 In
Premium Drug Copay/ and Out-of- MTM Program :
Mail Order Reduction Coinsurance: network Yes
Annual: $630 :No $3 - $100, 25% $6,700 In-
network

HealthPartners UnityPoint Health Symmetry (PPO) (H3416-002-2)
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 $39.00 Annual Drug Doctor All Your Drugs on $3,700 Not enough Enrollment begins
Deductible: Choice: Any Formulary :Yes data October 15, 2018
Pharmacy Drug: $100 Doctor available
Status: $39.00 Drug Restrictions:
Standard Cost- Health: Health Plan Out of Pocket Yes
Sharing $0.00 Deductible: $0 Spending Lower Your
Drug Copay/ Limit: $8,000 Drug Costs
Annual: $744 Part B Coinsurance: In and Out-
Premium $2 - $100, 31% of-network MTM Program :
Mail Order Reduction $3,500 In- Yes
Annual: $660 :No network

Health Alliance Medicare HMO 20 Rx (HMO) (H1463-003-0)
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: [?]

https://www.medicare.gov/find-a-plan/results/planresults/plan-list.aspx 6/8