Page 148 - Cover Letter and Evaluation for Gary Janke

10/8/2018 Your Plan Results
Retail $0.00 Annual Drug Doctor All Your Drugs on $5,050 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:
Preferred Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your
Part B Coinsurance: Spending Drug Costs
Annual: $2,055 Premium $0 - $95, 33% Limit: $4,900
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $1,870
Humana Gold Plus H4461-029 (HMO) (H4461-029-0)
Organization: Humana
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 $5,230 Coming Enrollment begins
Deductible: Choice: Plan Formulary :Yes Soon October 15, 2018
Pharmacy Drug: $0.00 $100 Doctors for
Status: Health: Most Services Drug Restrictions:
Preferred Cost- $0.00 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your
Part B Drug Copay/ Spending Drug Costs
Annual: $2,173 Premium Coinsurance: Limit: $6,700
Reduction $5 - $97, 31% In-network MTM Program :
Mail Order :No Yes
Annual: $1,964
Bright Advantage Flex (PPO) (H1393-001-0)
Organization: Bright 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 $5,200 Coming Enrollment begins
Deductible: Choice: Any Formulary :Yes Soon October 15, 2018
Pharmacy Drug: $0.00 $100 Doctor
Status: Health: Drug Restrictions:
Standard Cost- $0.00 Health Plan Out of Pocket Yes
Sharing Deductible: $0 Spending Lower Your
Part B Drug Copay/ Limit: Drug Costs
Annual: $2,168 Premium Coinsurance: $10,000 In
Reduction $2 - $95, 31% and Out-of- MTM Program :
Mail Order :No network Yes
Annual: $2,153 $5,900 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.

† No drug pricing data is currently available for this plan. All costs provided are based on average estimated costs.

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