Page 54 - Cover Letter and Evaluation for Barbara Lesswing

11/20/2017 Your Plan Results
Retail $0.00 Health Plan Doctor Choice: $13,630 Enroll
Annual: $9,925 Deductible: $0 Plan Doctors Only Includes $9,925
Part B (some for drug costs 3 out of 5 stars
Premium exceptions)
Reduction
:No Out of Pocket
Spending Limit:
$6,700 In-
network

Today's Options Premier 200 (PFFS) (H2816-001-0)
Organization: Universal American, A WellCare Company
Estimated Annual Monthly Deductibles: Health Benefits: Estimated Overall Star
Drug Costs: [?] Premium: [?] [?] [?] Annual Health Rating: [?]
and Drug Costs:
[?]
Retail $62.00 Health Plan Doctor Choice: $13,670 Enroll
Annual: $9,925 Deductible: $0 Plan Doctors for Includes $9,925
Part B Most Services for drug costs 3.5 out of 5
Premium stars
Reduction Out of Pocket
:No Spending Limit:
$3,400 In and
Out-of-network

Preferred Gold without Part D (HMO-POS) (H3305-007-0)
Organization: MVP HEALTH CARE
Estimated Annual Monthly Deductibles: Health Benefits: Estimated Overall Star
Drug Costs: [?] Premium: [?] [?] [?] Annual Health Rating: [?]
and Drug Costs:
[?]
Retail $116.60 Health Plan Doctor Choice: $14,600 Enroll
Annual: $9,925 Deductible: $0 Plan Doctors Only Includes $9,925
Part B (some for drug costs 4.5 out of 5
Premium exceptions) stars
Reduction
:No Out of Pocket
Spending Limit:
$6,700 In-
network

Univera SeniorChoice Select (HMO-POS) (H3351-001-0)
Organization: Excellus Health Plan, Inc
Estimated Annual Monthly Deductibles: Health Benefits: Estimated Overall Star
Drug Costs: [?] Premium: [?] [?] [?] Annual Health Rating: [?]
and Drug Costs:
[?]
Retail $135.00 Health Plan Doctor Choice: $14,900 Enroll
Annual: $9,925 Deductible: $0 Plan Doctors Only Includes $9,925
Part B (some for drug costs 4.5 out of 5
Premium exceptions) stars
Reduction
:No Out of Pocket
Spending Limit:
$5,500 In-
network

Notes:
Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
Extra Help from Medicare paying your drug costs.

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