Page 47 - 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 $179.00 Annual Drug Doctor Choice: All Your Drugs on $6,760 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $99.20 Only (some 4.5 out of 5
Status: Health: Health Plan exceptions) Drug Restrictions: stars
Standard Cost- $79.80 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $0 Spending Costs
Annual: $2,519 Premium - $100, 33% Limit: $5,500
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $2,331
Independent Health Medicare Passport Advantage (PPO) (H3344-
005-0)
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 $87.00 Annual Drug Doctor Choice: All Your Drugs on $6,130 Enroll
Deductible: $0 Any Doctor Formulary :Yes
Pharmacy Drug: $80.30 4.5 out of 5
Status: Health: Health Plan Out of Pocket Drug Restrictions: stars
Standard Cost- $6.70 Deductible: $0 Spending Yes
Sharing Drug Copay/ Limit: $10,000 Lower Your Drug
Part B Coinsurance: $0 In and Out-of- Costs
Annual: $2,521 Premium - $47, 33% - network
Reduction 50% $6,700 In- MTM Program :
Mail Order :No network Yes
Annual: $2,238

Univera SeniorChoice Value Plus (HMO-POS) (H3351-012-0)
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 $101.00 Annual Drug Doctor Choice: All Your Drugs on $6,180 Enroll
Deductible: $0 Plan Doctors Formulary :Yes
Pharmacy Drug: $97.90 Only (some 4.5 out of 5
Status: Health: Health Plan exceptions) Drug Restrictions: stars
Standard Cost- $3.10 Deductible: $0 Yes
Sharing Drug Copay/ Out of Pocket Lower Your Drug
Part B Coinsurance: $0 Spending Costs
Annual: $2,580 Premium - $100, 33% Limit: $6,000
Reduction In-network MTM Program :
Mail Order :No Yes
Annual: $2,368
AARP MedicareComplete (HMO) (H3379-040-0)
Organization: UnitedHealthcare
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 $6,070 Enroll
Deductible: Plan Doctors Formulary :No
Pharmacy Drug: $0.00 $330 for Most 3 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: $2,592 Premium Coinsurance: $3 Limit: $6,700
Reduction - $100, 26% In-network MTM Program :
Mail Order :No Yes
Annual: $2,282
Today's Options Advantage Plus 150A (PPO) (H2775-082-0)
Organization: Universal American, A WellCare Company

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