Page 105 - Cover Letter and Evaluation for John

10/9/2018 Your Plan Results
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star Rating:
Costs: [?] [?] Copay [?] / Restrictions [?] Health and [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $30.50 Annual Drug Doctor All Your Drugs on $5,930 Coming Soon Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $415 Doctors for
Status: $30.50 Most Services Drug Restrictions:
Preferred Cost- Health: Health Plan Yes
Sharing $0.00 Deductible: $0 Out of Pocket Lower Your Drug
Drug Copay/ Spending Costs
Annual: $3,161 Part B Coinsurance: Limit: $6,700
Premium $5 - $10, 25% In-network MTM Program :
Mail Order Reduction Yes
Annual: $2,895 :No
Health Net Seniority Plus Sapphire Premier II (HMO) (H3561-
006-0)
Organization: HEALTH NET COMMUNITY SOLUTIONS, INC.
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star Rating:
Costs: [?] [?] Copay [?] / Restrictions [?] Health and [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $34.80 Annual Drug Doctor All Your Drugs on $6,360 Coming Soon Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $250 Doctors for
Status: $34.80 Most Services Drug Restrictions:
Standard Cost- Health: Health Plan Yes
Sharing $0.00 Deductible: $0 Out of Pocket Lower Your Drug
Drug Copay/ Spending Costs
Annual: $3,206 Part B Coinsurance: Limit: $6,700
Premium $0 - $100, 28% In-network MTM Program :
Mail Order Reduction Yes
Annual: $3,147 :No
Health Net Seniority Plus Sapphire (HMO) (H0562-111-3)
Organization: Health Net of California
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star Rating:
Costs: [?] [?] Copay [?] / Restrictions [?] Health and [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $34.80 Annual Drug Doctor All Your Drugs on $6,300 Coming Soon Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $340 Doctors for
Status: $34.80 Most Services Drug Restrictions:
Standard Cost- Health: Health Plan Yes
Sharing $0.00 Deductible: $0 Out of Pocket Lower Your Drug
Drug Copay/ Spending Costs
Annual: $3,296 Part B Coinsurance: Limit: $6,700
Premium $0 - $100, 26% In-network MTM Program :
Mail Order Reduction Yes
Annual: $3,147 :No
Aetna Medicare Select Plan (HMO) (H0523-022-0)
Organization: Aetna Medicare
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star Rating:
Costs: [?] [?] Copay [?] / Restrictions [?] Health and [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $5,590 Coming Soon Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $0.00 Doctors for
Status: Health: Health Plan Most Services Drug Restrictions:
Preferred Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: Spending Costs
Annual: $3,309 Premium $0 - $100, 33% Limit: $3,400
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $3,438

https://www.medicare.gov/find-a-plan/results/planresults/plan-list.aspx 6/12