Page 146 - Cover Letter and Evaluation for Gary Janke

10/8/2018 Your Plan Results
Retail $0.00 Annual Drug Doctor All Your Drugs on $4,650 Coming Enrollment begins
Deductible: $0 Choice: Any Formulary :No Soon October 15, 2018
Pharmacy Drug: $0.00 Doctor
Status: Health: Health Plan Drug Restrictions:
Preferred Cost- $0.00 Deductible: $0 Out of Pocket Yes
Sharing Drug Copay/ Spending Lower Your
Part B Coinsurance: Limit: Drug Costs
Annual: $1,147 Premium $1 - $92, 33% $10,000 In Annual mail-order
Reduction and Out-of- MTM Program : costs include
Mail Order :No network Yes
Annual: $903 $6,700 In- premiums and co-
network
payments.

WellCare Dividend (HMO) (H1416-039-0)
Organization: WellCare
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $0.00 Annual Drug Doctor All Your Drugs on $4,590 Coming Enrollment begins
Deductible: $0 Choice: Plan Formulary :Yes Soon 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
Part B Coinsurance: Spending Drug Costs This plan is
Annual: $1,734 Premium $4 - $99, 33% Limit: $6,700
Reduction In-network MTM Program : compared in your
Mail Order :Yes Yes
Annual: $1,295 evaluation.
BlueAdvantage Ruby (PPO) (H7917-013-0)
Organization: BlueCross BlueShield of Tennessee
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $106.00 Annual Drug Doctor All Your Drugs on $5,560 Coming Enrollment begins
Deductible: $0 Choice: Any Formulary :No Soon October 15, 2018
Pharmacy Drug: Doctor
Status: $59.30 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: $0 Out of Pocket Yes
Sharing $46.70 Drug Copay/ Spending Lower Your
Coinsurance: Limit: Drug Costs
Annual: $1,690 Part B $1 - $65, 33% $10,000 In
Premium and Out-of- MTM Program :
Mail Order Reduction network Yes
Annual: $1,480 :No $4,800 In-
network

WellCare Rx (HMO) (H1416-042-0)
Organization: WellCare
Estimated Monthly Deductibles Health Drug Coverage Estimated Overall
Annual Drug Premium: [?] and Drug Benefits: [?] [?] , Drug Annual Star
Costs: [?] [?] Copay [?] / Restrictions [?] Health and Rating: [?]
Coinsurance: and Other Drug
[?] Programs: Costs: [?]
Retail $14.30 Annual Drug Doctor All Your Drugs on $5,040 Coming Enrollment begins
Deductible: Choice: Plan Formulary :Yes Soon October 15, 2018
Pharmacy Drug: $415 Doctors for
Status: $14.30 Most Services Drug Restrictions:
Standard Cost- Health: Health Plan Yes
Sharing $0.00 Deductible: $0 Out of Pocket Lower Your
Drug Copay/ Spending Drug Costs
Annual: $2,109 Part B Coinsurance: Limit: $6,700
Premium $1 - $99, 25% In-network MTM Program :
Mail Order Reduction Yes
Annual: $1,629 :No

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