Page 69 - Cover Letter and Evaluation for Kirk Schmidt

10/31/2017 Your Plan Results
Aspire Health Value (HMO) (H8764-003-0)
Organization: Aspire Health Plan
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 $35.50 Annual Drug Doctor Choice: All Your Drugs on $7,530 Enroll
Deductible: Plan Doctors Formulary :No
Pharmacy Drug: $35.50 $380 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: $4,017 Premium Coinsurance: $3 Limit: $6,000
Reduction - $47, 25% - In-network MTM Program :
Mail Order :No 50% Yes
Annual: $3,983
Aspire Health Advantage (HMO) (H8764-001-0)
Organization: Aspire Health Plan
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 $129.00 Annual Drug Doctor Choice: All Your Drugs on $7,930 Enroll
Deductible: Plan Doctors Formulary :No
Pharmacy Drug: $50.00 $150 for Most 3.5 out of 5
Status: Health: Services Drug Restrictions: stars
Standard Cost- $79.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $4,178 Premium Coinsurance: $2 Limit: $3,400
Reduction - $95, 30% In-network MTM Program :
Mail Order :No Yes
Annual: $4,129
Aspire Health Plus (HMO-POS) (H8764-002-0)
Organization: Aspire Health Plan
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 $247.00 Annual Drug Doctor Choice: All Your Drugs on $8,620 Enroll
Deductible: $0 Plan Doctors Formulary :No
Pharmacy Drug: $59.00 Only (some 3.5 out of 5
Status: Health: Health Plan exceptions) Drug Restrictions: stars
Standard Cost- $188.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $0 Spending Costs
Annual: $4,262 Premium - $90, 33% Limit: $0 In
Reduction and Out-of- MTM Program :
Mail Order :No network Yes
Annual: $4,221 $0 In-network

Notes:
Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
Extra Help from Medicare paying your drug costs.

All three of these plans have very expensive drug
coverage for the drugs that you take.

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