Page 60 - Cover Letter & Evaluation for Patricia Letizia

10/10/2018 Your Plan Results
Spirit Rx (HMO-POS) (H5211-004-0)
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 $219.00 Annual Drug Doctor All Your Drugs on $5,550 Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: Doctors Only 4.5 out of 5
Status: $71.90 Health Plan (some Drug Restrictions: stars
Standard Cost- Health: Deductible: exceptions) Yes
Sharing $147.10 $1,500 Out-of- Lower Your
network Out of Pocket Drug Costs
Annual: $1,292 Part B Drug Copay/ Spending
Premium Coinsurance: Limit: $1,200 MTM Program :
Mail Order Reduction $0 - $100, 33% In-network Yes
Annual: $1,256 :No $3,500 Out-
of-network

UnitedHealthcare MedicareComplete Open (PPO) (H0294-004-0)
Organization: UnitedHealthcare
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 $44.00 Annual Drug Doctor All Your Drugs on $5,300 † Enrollment begins
Annual: Deductible: Choice: Any Formulary :Not October 15, 2018
†
$1,538 Drug: $325 Doctor Available 4.5 out of 5
$32.20
stars
Health Plan Out of Pocket Drug Restrictions:
Mail Order Health: Deductible: $0 Spending Not Available
Annual: Not $11.80 Limit: $6,700
Available Drug Copay/ Lower Your
Part B Coinsurance: In and Out- Drug Costs
Premium $4 - $100, 26% of-network
Reduction $6,700 In- MTM Program :
:No network Yes

AARP MedicareComplete (HMO) (H5253-004-0)
Organization: UnitedHealthcare
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 $24.00 Annual Drug Doctor All Your Drugs on $4,540 † Enrollment begins
Annual: Drug: Deductible: Choice: Plan Formulary :Not 4 out of 5 October 15, 2018
†
$1,303 $22.60 $265 Doctors for Available stars
Health Plan Most Services Drug Restrictions:
Mail Order Health: Deductible: $0 Out of Pocket Not Available
Annual: Not $1.40 Spending
Available Drug Copay/ Lower Your
Part B Coinsurance: Limit: $4,900 Drug Costs
Premium $2 - $95, 28% In-network
Reduction MTM Program :
:No Yes
AARP MedicareComplete Premier (HMO) (H5253-075-0)
Organization: UnitedHealthcare
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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