Page 44 - Cover Letter and Evaluation for Barbara Lesswing

11/20/2017 Your Plan Results
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 $0.00 Annual Drug Doctor Choice: All Your Drugs on $5,560 Enroll
Deductible: $0 Plan Doctors Formulary :No
Pharmacy Drug: $0.00 for Most 3 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Standard Cost- $0.00 Deductible: Yes
Sharing $190 In- Out of Pocket Lower Your Drug
Part B network Spending Costs
Annual: $2,077 Premium Drug Copay/ Limit: $5,000
Reduction Coinsurance: $0 In-network MTM Program :
Mail Order :No - $47, 33% - Yes
Annual: $1,894 48%
WellCare Essential (HMO) (H3361-134-0)
Organization: WellCare
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 $0.00 Annual Drug Doctor Choice: All Your Drugs on $5,280 Enroll
Deductible: $0 Plan Doctors Formulary :No
Pharmacy Drug: $0.00 for Most 3 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Standard Cost- $0.00 Deductible: Yes
Sharing $190 In- Out of Pocket Lower Your Drug
Part B network Spending Costs
Annual: $2,077 Premium Drug Copay/ Limit: $5,000
Reduction Coinsurance: $0 In-network MTM Program :
Mail Order :No - $47, 33% - Yes
Annual: $1,894 48%
BlueCross BlueShield Senior Blue 651 (HMO) (H3384-019-0)
Organization: BlueCross BlueShield of WNY and BlueShield of NENY
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 $117.00 Annual Drug Doctor Choice: All Your Drugs on $5,700 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $71.80 for Most 4 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Preferred Cost- $45.20 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $4 Spending Costs
Annual: $2,100 Premium - $94, 33% Limit: $6,700
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $2,057
Fidelis Medicare Advantage Flex (HMO-POS) (H3328-003-0)
Organization: Fidelis Care
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 $38.00 Annual Drug Doctor Choice: All Your Drugs on $5,220 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $38.00 $125 Only (some 3 out of 5
Status: Health: exceptions) 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: $2,112 Premium Coinsurance: $0 Limit: $6,700
Reduction - $100, 28% In-network MTM Program :
Mail Order :No Yes
Annual: $1,883
BlueCross BlueShield Forever Blue Value (PPO) (H5526-016-0)
Organization: BlueCross BlueShield of WNY and BlueShield of NENY

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