Page 107 - Cover Letter and Evaluation for John

10/9/2018 Your Plan Results
Retail $81.00 Annual Drug Doctor All Your Drugs on $7,700 Coming Soon Enrollment begins
Deductible: $0 Choice: Any Formulary :Yes October 15, 2018
Pharmacy Drug: Doctor
Status: $39.60 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: Out of Pocket Yes
Sharing $41.40 $750 annual Spending Lower Your Drug
deductible Limit: $10,000 Costs
Annual: $3,785 Part B Drug Copay/ In and Out-
Premium Coinsurance: of-network MTM Program :
Mail Order Reduction $0 - $100, 33% $6,700 In- Yes
Annual: $3,913 :No network

Anthem MediBlue Coordination Plus (HMO) (H0544-071-0)
Organization: Anthem Blue Cross
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 $7,330 Coming Soon Enrollment begins
Deductible: Choice: Plan Formulary :Yes October 15, 2018
Pharmacy Drug: $415 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: $4,089 Part B Coinsurance: Limit: $6,700
Premium $0 - $95, 25% In-network MTM Program :
Mail Order Reduction Yes
Annual: $3,926 :No
Easy Choice Best Plan (HMO) (H5087-016-0)
Organization: Easy Choice Health Plan
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 $6,540 Coming Soon Enrollment begins
Deductible: $0 Choice: Plan Formulary :No October 15, 2018
Pharmacy Drug: $0.00 Doctors for
Status: Health: Health Plan Most Services Drug Restrictions:
Standard Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: Spending Costs
Annual: $4,502 Premium $0 - $99, 33% Limit: $2,500
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $3,984
Easy Choice Plus Plan (HMO) (H5087-002-0)
Organization: Easy Choice Health Plan
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 $25.00 Annual Drug Doctor All Your Drugs on $7,890 Coming Soon Enrollment begins
Deductible: Choice: Plan Formulary :No October 15, 2018
Pharmacy Drug: $415 Doctors for
Status: $25.00 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: $5,350 Part B Coinsurance: Limit: $2,500
Premium $0 - $99, 25% In-network MTM Program :
Mail Order Reduction Yes
Annual: $4,807 :No
Inter Valley Health Plan Service To Seniors (HMO) (H0545-001-0)
Organization: Inter Valley Health Plan

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