Page 147 - Cover Letter and Evaluation for Gary Janke

10/8/2018 Your Plan Results
Aetna Medicare Premier Plan (PPO) (H5521-141-0)
Organization: Aetna Medicare
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 $4,360 Coming Enrollment begins
Deductible: $0 Choice: Any Formulary :Yes 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: $1,804 Premium $0 - $100, 33% $10,000 In
Reduction and Out-of- MTM Program :
Mail Order :Yes network Yes
Annual: $1,799 $5,950 In-
network

BlueAdvantage Diamond (PPO) (H7917-009-0)
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 $221.00 Annual Drug Doctor All Your Drugs on $6,690 Coming Enrollment begins
Deductible: $0 Choice: Any Formulary :No Soon October 15, 2018
Pharmacy Drug: Doctor
Status: $90.00 Health Plan Drug Restrictions:
Preferred Cost- Health: Deductible: $0 Out of Pocket Yes
Sharing $131.00 Drug Copay/ Spending Lower Your
Coinsurance: Limit: Drug Costs
Annual: $2,059 Part B $1 - $50, 33% $10,000 In
Premium and Out-of- MTM Program :
Mail Order Reduction network Yes
Annual: $1,848 :No $3,700 In-
network

Clover Health Choice (PPO) (H5141-033-0)
Organization: Clover Health
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 $5,450 Coming Enrollment begins
Deductible: Choice: Any Formulary :Yes Soon October 15, 2018
Pharmacy Drug: $0.00 $100 Doctor
Status: Health: Drug Restrictions:
Preferred Cost- $0.00 Health Plan Out of Pocket Yes
Sharing Deductible: $0 Spending Lower Your
Part B Drug Copay/ Limit: $6,700 Drug Costs
Annual: $2,242 Premium Coinsurance: In and Out-
Reduction $2 - $90, 31% of-network MTM Program :
Mail Order :No $6,700 In- Yes
Annual: $1,851 network

Amerivantage Classic (HMO) (H2593-022-0)
Organization: Amerigroup
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: [?]

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