Page 108 - 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 $0.00 Annual Drug Doctor All Your Drugs on $8,000 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: $6,005 Premium $0 - $47, 25% Limit: $2,000
Reduction - 33% In-network MTM Program :
Mail Order :No Yes
Annual: $6,197
Blue Shield Promise Coordinated Choice Plan (HMO) (H5928-037-
0)
Organization: Blue Shield of California Promise 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 $34.80 Annual Drug Doctor All Your Drugs on $9,780 Coming Soon Enrollment begins
Deductible: Choice: Plan Formulary :No 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: $7,042 Part B Coinsurance: Limit: $6,700
Premium $0, 25% In-network MTM Program :
Mail Order Reduction Yes
Annual: $6,006 :No
Inter Valley Health Plan Desert Preferred Choice (HMO) (H0545-
012-0)
Organization: Inter Valley 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 $11,200 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: $9,413 Premium $0 - $37, 30% Limit: $3,400
Reduction - 33% In-network MTM Program :
Mail Order :No Yes
Annual: $9,405
SCAN Classic (HMO) (H5425-008-0)
Organization: SCAN 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 $12,180 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:
Preferred Cost- $0.00 Deductible: $0 No
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: Spending Costs
Annual: $9,839 Premium $0 - $95, 33% Limit: $2,400
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $9,545

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