Page 59 - Cover Letter & Evaluation for Patricia Letizia

10/10/2018 Your Plan Results
Retail $35.00 Annual Drug Doctor All Your Drugs on $3,900 Plan too new Enrollment begins
Deductible: Choice: Plan Formulary :Yes to be October 15, 2018
Pharmacy Drug: $260 Doctors for measured
Status: $35.00 Most Services Drug Restrictions:
Preferred Cost- Health: Health Plan Yes
Sharing $0.00 Deductible: $0 Out of Pocket Lower Your
Drug Copay/ Spending Drug Costs
Annual: $812 Part B Coinsurance: Limit: $4,900
Premium $2 - $84, 28% In-network MTM Program :
Mail Order Reduction Yes
Annual: $726 :No
Humana Gold Choice H8145-006 (PFFS) (H8145-006-0)
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 $94.00 Annual Drug Doctor All Your Drugs on $5,090 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $415 Doctors for 3.5 out of 5
Status: $29.50 Most Services Drug Restrictions: stars
Preferred Cost- Health: Health Plan Yes
Sharing $64.50 Deductible: Out of Pocket Lower Your
$200 In- Spending Drug Costs
Annual: $828 Part B network Limit: $6,700
Premium $200 Out-of- In and Out- MTM Program :
Mail Order Reduction network of-network Yes
Annual: $354 :No Drug Copay/
Coinsurance:
$6 - $100, 25%
HumanaChoice H5216-001 (PPO) (H5216-001-0)
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 $79.00 Annual Drug Doctor All Your Drugs on $4,580 Enrollment begins
Deductible: Choice: Any Formulary :Yes October 15, 2018
Pharmacy Drug: $325 Doctor 4 out of 5
Status: $30.10 Drug Restrictions: stars
Preferred Cost- Health: Health Plan Out of Pocket Yes
Sharing $48.90 Deductible: $0 Spending Lower Your
Drug Copay/ Limit: Drug Costs
Annual: $836 Part B Coinsurance: $10,000 In
Premium $6 - $100, 26% and Out-of- MTM Program :
Mail Order Reduction network Yes
Annual: $361 :No $6,700 In-
network

Essence Rx (HMO-POS) (H5211-002-0)
Organization: Security Health Plan of Wisconsin, Inc.
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 $77.00 Annual Drug Doctor All Your Drugs on $4,460 Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $330 Doctors Only 4.5 out of 5
Status: $53.80 (some Drug Restrictions: stars
Standard Cost- Health: Health Plan exceptions) Yes
Sharing $23.20 Deductible: Lower Your
$1,500 Out-of- Out of Pocket Drug Costs
Annual: $1,075 Part B network Spending
Premium Drug Copay/ Limit: $3,400 MTM Program :
Mail Order Reduction Coinsurance: In-network Yes
Annual: $1,039 :No $0 - $100, 26% $3,500 Out-
of-network

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