Page 65 - Cover Letter and Evaluation for Mike Peaseley

11/17/2017 Your Medicare Health Plan Comparison

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Your Plan Comparison
Zip Code: 98499
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs
and coverage and star ratings. Drug List ID: 6951340928
Password Date: 11/16/2017
Important Coverage Information

You are now viewing 2018 plan data. View 2017 plan data.

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A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment
will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the
enrollee is not responsible for obtaining (prior) authorization.
Some Dental Coverage Some Vision Coverage Some Hearing Coverage
This is the plan
* Estimated
compared in your
evaluation

Aetna Medicare Choice Plan (PPO) Aetna Medicare Select Plan (PPO)
(H5521-127) Plan Type: (H5521-128) Plan Type:
Organization: Aetna Medicare Organization: Aetna Medicare

Members: 1-800-282-5366 Members: 1-800-282-5366
711(TTY/TDD) 711(TTY/TDD)
Non Members: 1-855-338-7027 Non Members: 1-855-338-7027
711(TTY/TDD) 711(TTY/TDD)
Coverage: Provides health and drug coverage Coverage: Provides health and drug coverage

Benefits Highlights

Aetna Medicare Choice Plan (PPO) Aetna Medicare Select Plan (PPO)
$26.40 $59.50
Monthly health plan premium

$750 annual deductible $0
Health plan deductible

In-Network: No In-Network: No
Other health plan deductibles?
$10,000 In and Out-of-network $8,500 In and Out-of-network
Maximum out-of-pocket enrollee $6,700 In-network $5,900 In-network
responsibility (does not include
prescription drugs)
[?]
Yes No
Optional supplemental benefits

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