Page 57 - Cover Letter & Evaluation for Patricia Letizia

10/10/2018 Your Plan Results
Retail $0.00 Annual Drug Doctor All Your Drugs on $3,500 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $0.00 $315 Doctors for 4 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: $6,700
Reduction $6 - $100, 26% In-network MTM Program :
Mail Order :Yes Yes
Annual: $0
ProHealth Senior Preferred Elite (w/Rx) (HMO) (H5262-011-0)
Organization: Senior Preferred
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 $20.00 Annual Drug Doctor All Your Drugs on $3,420 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $250 Doctors for 4.5 out of 5
Status: $20.00 Most Services Drug Restrictions: stars
Standard Cost- Health: Health Plan Yes
Sharing $0.00 Deductible: $0 Out of Pocket Lower Your
Drug Copay/ Spending Drug Costs
Annual: $540 Part B Coinsurance: Limit: $3,400
Premium $4 - $47, 28% In-network MTM Program :
Mail Order Reduction - 40% Yes
Annual: $384 :No
Network Health Medicare Anywhere (PPO) (H5215-010-0)
Organization: Network Health Medicare Advantage Plans
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 $25.00 Annual Drug Doctor All Your Drugs on $3,880 Enrollment begins
Deductible: Choice: Any Formulary :Yes October 15, 2018
Pharmacy Drug: $250 Doctor 4 out of 5
Status: $25.00 Drug Restrictions: stars
Preferred Cost- Health: Health Plan Out of Pocket Yes
Sharing $0.00 Deductible: $0 Spending Lower Your
Drug Copay/ Limit: $4,500 Drug Costs
Annual: $692 Part B Coinsurance: In and Out-
Premium $2 - $84, 28% of-network MTM Program :
Mail Order Reduction $4,500 In- Yes
Annual: $606 :No network

Humana Value Plus H5216-173 (PPO) (H5216-173-0)
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 $31.90 Annual Drug Doctor All Your Drugs on $4,430 Enrollment begins
Deductible: Choice: Any Formulary :Yes October 15, 2018
Pharmacy Drug: $405 Doctor 4 out of 5
Status: $31.90 Drug Restrictions: stars
Preferred Cost- Health: Health Plan Out of Pocket Yes
Sharing $0.00 Deductible: Spending Lower Your
Coming soon Limit: Drug Costs
Annual: $713 Part B Drug Copay/ $10,000 In
Premium Coinsurance: and Out-of- MTM Program :
Mail Order Reduction $0 - $100, 25% network Yes
Annual: $679 :No $6,700 In-
network

Humana Gold Plus H6622-002 (HMO) (H6622-002-0)
Organization: Humana

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