Page 38 - Cover Letter & Evaluation for Patricia Letizia

10/11/2018 Your Plan Results
Retail $115.00 Annual Drug Doctor All Your Drugs on $4,580 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: Doctors for 4 out of 5
Status: $34.10 Health Plan Most Services Drug Restrictions: stars
Standard Cost- Health: Deductible: $0 Yes
Sharing $80.90 Drug Copay/ Out of Pocket Lower Your
Coinsurance: Spending Drug Costs
Annual: $802 Part B $0 - $47, 33% Limit: $4,000
Premium - 50% In-network MTM Program :
Mail Order Reduction Yes
Annual: $618 :No
MeridianCare Edge (HMO) (H5779-006-0)
Organization: MeridianCare
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 $27.40 Annual Drug Doctor All Your Drugs on $4,320 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $415 Doctors for 3 out of 5
Status: $27.40 Most Services Drug Restrictions: stars
Standard Cost- Health: Health Plan No
Sharing $0.00 Deductible: Out of Pocket Lower Your
Coming soon Spending Drug Costs
Annual: $824 Part B Drug Copay/ Limit: $6,700
Premium Coinsurance: In-network MTM Program :
Mail Order Reduction 0% - 25% Yes
Annual: $1,359 :No
Humana Gold Choice H8145-008 (PFFS) (H8145-008-0)
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 $177.00 Annual Drug Doctor All Your Drugs on $6,210 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $380 Doctors for 3.5 out of 5
Status: $32.70 Most Services Drug Restrictions: stars
Preferred Cost- Health: Health Plan Yes
Sharing $144.30 Deductible: Out of Pocket Lower Your
$200 In- Spending Drug Costs
Annual: $867 Part B network Limit: $6,700
Premium $200 Out-of- In and Out- MTM Program :
Mail Order Reduction network of-network Yes
Annual: $392 :No Drug Copay/
Coinsurance:
$6 - $100, 25%
Health Alliance Medicare POS 10 Rx (HMO-POS) (H1463-019-0)
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 $155.00 Annual Drug Doctor All Your Drugs on $4,930 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: Doctors Only 4 out of 5
Status: $47.70 Health Plan (some Drug Restrictions: stars
Standard Cost- Health: Deductible: $0 exceptions) Yes
Sharing $107.30 Drug Copay/ Lower Your
Coinsurance: Out of Pocket Drug Costs
Annual: $965 Part B $0 - $47, 33% Spending
Premium - 50% Limit: $5,750 MTM Program :
Mail Order Reduction In and Out- Yes
Annual: $781 :No of-network
$4,500 In-
network

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