Page 58 - Cover Letter & Evaluation for Patricia Letizia

10/10/2018 Your Plan Results
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 $35.00 Annual Drug Doctor All Your Drugs on $3,850 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $200 Doctors for 4 out of 5
Status: $21.10 Most Services Drug Restrictions: stars
Preferred Cost- Health: Health Plan Yes
Sharing $13.90 Deductible: $0 Out of Pocket Lower Your
Drug Copay/ Spending Drug Costs
Annual: $728 Part B Coinsurance: Limit: $4,500
Premium $6 - $100, 29% In-network MTM Program :
Mail Order Reduction Yes
Annual: $253 :No
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

Anthem MediBlue Access (PPO) (H4036-008-0)
Organization: Anthem Blue Cross and Blue Shield
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 $27.00 Annual Drug Doctor All Your Drugs on $3,760 Enrollment begins
Deductible: $0 Choice: Any Formulary :Yes October 15, 2018
Pharmacy Drug: Doctor 4 out of 5
Status: $27.00 Health Plan Drug Restrictions: stars
Preferred Cost- Health: Deductible: $0 Out of Pocket No
Sharing $0.00 Drug Copay/ Spending Lower Your
Coinsurance: Limit: $9,000 Drug Costs
Annual: $756 Part B $0 - $95, 33% In and Out-
Premium of-network MTM Program :
Mail Order Reduction $4,000 In- Yes
Annual: $644 :No network

Network Health Medicare Explore (HMO) (H5644-002-0)
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: [?]

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