Page 45 - 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 $136.00 Annual Drug Doctor Choice: All Your Drugs on $6,160 Enroll
Deductible: $0 Any Doctor Formulary :Yes
Pharmacy Drug: $74.70 4.5 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Preferred Cost- $61.30 Deductible: $0 Spending Yes
Sharing Drug Copay/ Limit: $10,000 Lower Your Drug
Part B Coinsurance: $4 In and Out-of- Costs
Annual: $2,120 Premium - $42, 33% - network
Reduction 50% $6,700 In- MTM Program :
Mail Order :No network Yes
Annual: $2,087

Univera SeniorChoice Value (HMO) (H3351-010-0)
Organization: Excellus Health Plan, Inc
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 $62.00 Annual Drug Doctor Choice: All Your Drugs on $5,700 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $62.00 for Most 4.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Standard Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $0 Spending Costs
Annual: $2,149 Premium - $100, 33% Limit: $6,700
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $1,937
BlueCross BlueShield Forever Blue 751 (PPO) (H5526-004-0)
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 $198.00 Annual Drug Doctor Choice: All Your Drugs on $6,540 Enroll
Deductible: $0 Any Doctor Formulary :Yes
Pharmacy Drug: $95.20 4.5 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Preferred Cost- $102.80 Deductible: $0 Spending Yes
Sharing Drug Copay/ Limit: $10,000 Lower Your Drug
Part B Coinsurance: $2 In and Out-of- Costs
Annual: $2,267 Premium - $94, 33% network
Reduction $6,700 In- MTM Program :
Mail Order :No network Yes
Annual: $2,247

Today's Options Advantage Plus 550B (PPO) (H2775-088-0)
Organization: Universal American, A WellCare Company
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 $19.00 Annual Drug Doctor Choice: All Your Drugs on $5,510 Enroll
Deductible: $0 Any Doctor Formulary :No
Pharmacy Drug: $19.00 4 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Preferred Cost- $0.00 Deductible: $0 Spending Yes
Sharing Drug Copay/ Limit: $6,700 Lower Your Drug
Part B Coinsurance: $2 In and Out-of- Costs
Annual: $2,302 Premium - $90, 33% network
Reduction $6,700 In- MTM Program :
Mail Order :No network Yes
Annual: $2,001

Today's Options Premier Plus 650B (PFFS) (H2816-019-0)
Organization: Universal American, A WellCare Company

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