Page 49 - Cover Letter and Evaluation for Barbara Lesswing

11/20/2017 Your Plan Results
GoldSecure with Part D (HMO-POS) (H3305-030-0)
Organization: MVP HEALTH 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 $25.00 Annual Drug Doctor Choice: All Your Drugs on $6,650 Enroll
Deductible: Plan Doctors Formulary :No
Pharmacy Drug: $23.90 $400 Only (some 4.5 out of 5
Status: Health: exceptions) Drug Restrictions: stars
Standard Cost- $1.10 Health Plan Yes
Sharing Deductible: $0 Out of Pocket Lower Your Drug
Part B Drug Copay/ Spending Costs
Annual: $2,797 Premium Coinsurance: $1 Limit: $6,700
Reduction - $47, 25% - In-network MTM Program :
Mail Order :No 36% Yes
Annual: $2,635
UnitedHealthcare MedicareComplete Choice Plan 1 (Regional PPO)
(R5342-001-0)
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 $17.00 Annual Drug Doctor Choice: All Your Drugs on $6,330 Enroll
Deductible: Any Doctor Formulary :No
Pharmacy Drug: $17.00 $350 3.5 out of 5
Status: Health: Out of Pocket Drug Restrictions: stars
Standard Cost- $0.00 Health Plan Spending Yes
Sharing Deductible: $0 Limit: $10,000 Lower Your Drug
Part B Drug Copay/ In and Out-of- Costs
Annual: $2,816 Premium Coinsurance: $3 network
Reduction - $100, 26% $6,700 In- MTM Program :
Mail Order :No network Yes
Annual: $2,506

UnitedHealthcare MedicareComplete Choice Plan 3 (Regional PPO)
(R5342-005-0)
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 $47.00 Annual Drug Doctor Choice: All Your Drugs on $6,390 Enroll
Deductible: Any Doctor Formulary :No
Pharmacy Drug: $28.20 $225 3.5 out of 5
Status: Health: Out of Pocket Drug Restrictions: stars
Standard Cost- $18.80 Health Plan Spending Yes
Sharing Deductible: $0 Limit: $10,000 Lower Your Drug
Part B Drug Copay/ In and Out-of- Costs
Annual: $2,825 Premium Coinsurance: $3 network
Reduction - $100, 28% $6,700 In- MTM Program :
Mail Order :No network Yes
Annual: $2,515

WellSelect with Part D (PPO) (H9615-012-0)
Organization: MVP HEALTH 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: [?]

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