Page 46 - 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 $24.00 Annual Drug Doctor Choice: All Your Drugs on $5,780 Enroll
Deductible: $0 Plan Doctors Formulary :No
Pharmacy Drug: $24.00 for Most 3.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Preferred Cost- $0.00 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $2 Spending Costs
Annual: $2,362 Premium - $90, 33% Limit: $6,700
Reduction In and Out-of- MTM Program :
Mail Order :No network Yes
Annual: $2,061

BlueCross BlueShield Forever Blue Focus (PPO) (H5526-019-0)
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 $61.00 Annual Drug Doctor Choice: All Your Drugs on $5,860 Enroll
Deductible: Any Doctor Formulary :Yes
Pharmacy Drug: $61.00 $290 4.5 out of 5
Status: Health: Out of Pocket Drug Restrictions: stars
Preferred Cost- $0.00 Health Plan Spending Yes
Sharing Deductible: $0 Limit: $10,000 Lower Your Drug This is the plan that
Part B Drug Copay/ In and Out-of- Costs you are currently
Annual: $2,368 Premium Coinsurance: network
Reduction $10 - $94, 27% $6,700 In- MTM Program : enrolled in.
Mail Order :No network Yes
Annual: $2,308

Independent Health Encompass 65 Basic (HMO) (H3362-017-0)
Organization: Independent Health
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 $118.00 Annual Drug Doctor Choice: All Your Drugs on $6,000 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $86.30 for Most 4.5 out of 5
Status: Health: Health Plan Services Drug Restrictions: stars
Standard Cost- $31.70 Deductible: $0 Yes Estimated costs for
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $0 Spending Costs your Rx drugs in
Annual: $2,455 Premium - $47, 33% - Limit: $6,700
Reduction 50% In-network MTM Program : 2018.
Mail Order :No Yes
Annual: $2,164
Independent Health's Encompass 65 Core (HMO) (H3362-033-0)
Organization: Independent Health
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 $65.00 Annual Drug Doctor Choice: All Your Drugs on $6,290 Enroll
Deductible: Plan Doctors Formulary :Yes
Pharmacy Drug: $65.00 $150 for Most 4.5 out of 5
Status: Health: Services 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: $2,487 Premium Coinsurance: $0 Limit: $6,700
Reduction - $47, 29% - In-network MTM Program :
Mail Order :No 50% Yes
Annual: $2,204
Univera SeniorChoice Secure (HMO-POS) (H3351-002-0)
Organization: Excellus Health Plan, Inc

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