Page 58 - Cover Letter and Evaluation for Mike Peaseley

11/17/2017 Your Plan Results
Aetna Medicare Select Plan (PPO) (H5521-128-0)
Organization: Aetna Medicare
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $86.00 Annual Drug Doctor Choice: All Your Drugs on $5,170 Enroll
Deductible: $0 Any Doctor Formulary :Yes
Pharmacy Drug: $26.50 4 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars This plan is
Preferred Cost- $59.50 Deductible: $0 Spending Yes compared in your
Sharing Drug Copay/ Limit: $8,500 Lower Your Drug
Part B Coinsurance: $0 In and Out-of- Costs evaluation
Annual: $1,152 Premium - $100, 33% network
Reduction $5,900 In- MTM Program :
Mail Order :No network Yes
Annual: $1,174

Soundpath Health Peak + Rx (HMO) (H9302-011-0)
Organization: Soundpath Health
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $4,890 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 $160 for Most 3.5 out of 5
Status: Health: Services Drug Restrictions: stars
Standard Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $1,174 Premium Coinsurance: $3 Limit: $6,700
Reduction - $47, 30% - In-network MTM Program :
Mail Order :No 50% Yes
Annual: $1,957
Premera Blue Cross Medicare Advantage (HMO) (H7245-001-0)
Organization: Premera Blue Cross Medicare Advantage
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor Choice: All Your Drugs on $4,880 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 $340 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $1,283 Premium Coinsurance: $5 Limit: $6,200
Reduction - $42, 26% - In-network MTM Program :
Mail Order :No 35% Yes
Annual: $1,188
Humana Gold Plus H5619-061 (HMO) (H5619-061-0)
Organization: Arcadian Health Plan, Inc.
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall Star
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Rating: [?]
Costs: [?] [?] Copay [?] / Restrictions [?] Health and
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $47.00 Annual Drug Doctor Choice: All Your Drugs on $5,260 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $0.00 $100 for Most 4 out of 5
Status: Health: Services Drug Restrictions: stars
Preferred Cost- $47.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $1,444 Premium Coinsurance: $2 Limit: $5,000
Reduction - $100, 31% In-network MTM Program :
Mail Order :No Yes
Annual: $919

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