Page 59 - Cover Letter and Evaluation for Barbara Lesswing

11/18/2017 Your Medicare Health Plan Comparison

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Your Plan Comparison
Zip Code: 14031
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs
and coverage and star ratings. Drug List ID: 1026286272
Password Date: 11/18/2017
Important Coverage Information

You are now viewing 2018 plan data. View 2017 plan data.

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A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment
will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the
enrollee is not responsible for obtaining (prior) authorization.
Some Dental Coverage Some Vision Coverage Some Hearing Coverage
* Estimated Your current plan.

Independent Health Encompass 65 (HMO) Independent Health Encompass 65 Basic (HMO)
(H3362-016) Plan Type: (H3362-017) Plan Type:
Organization: Independent Health Organization: Independent Health

Members: 1-800-665-1502 Members: 1-800-665-1502
1-800-432-1110(TTY/TDD) 1-800-432-1110(TTY/TDD)
Non Members: 1-800-958-4405 Non Members: 1-800-958-4405
1-888-357-9167(TTY/TDD) 1-888-357-9167(TTY/TDD)
Coverage: Provides health coverage only (drug costs are retail Coverage: Provides health and drug coverage
estimates)
Your current plan's out-
of-pocket limit is almost

twice as high as the
Independent Health
Encompass 65 Plan.
Benefits Highlights

Independent Health Encompass 65 Independent Health Encompass 65
(HMO) Basic (HMO)
$0.00 $31.70
Monthly health plan premium
$0 $0
Health plan deductible

In-Network: No In-Network: No
Other health plan deductibles?
$3,400 In-network $6,700 In-network
Maximum out-of-pocket enrollee
responsibility (does not include
prescription drugs)
[?]

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