Page 51 - Cover Letter and Appendices for Melanie April 2019
P. 51
Your Medicare Health Plan Details https://www.medicare.gov/find-a-plan/results/planresults/plan-details.as...
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Zip Code: 75069
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs Drug List ID: 8186191616
and more coverage and star ratings.
Password Date: 05/01/2018
Important Coverage Information
Symbols
Nationwide Coverage
* Estimated
Express Scripts Medicare - PO Box 66535 Overall Star Rating: Enroll
Saver (PDP) ST LOUIS, MO 63166 Members: [?]
1-800-758-4574 1-800-716-3231
(S5660-238-0) (TTY/TDD) Non Members: 3.5 out of 5 stars
1-866-477-5704 1-800-716-3231 Call either of these
Organization: Express Scripts Medicare (TTY/TDD) numbers to enroll.
Plan Type: PDP You will likely be
asked to provide
proof that you have
had creditable Rx
NOTE: Health Plan Benefits are based on Original Medicare coverage since you
turned 65.
Fixed Costs
Monthly Drug Plan Premium [?] $24.00
Monthly Health Plan Premium [?] N/A
Annual Drug Deductible [?] $415.00
Medicare costs at a glance
Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs
Cost For Rest of Year (based on enrollment today) [?]
CVS Pharmacy #05380 $1,063.19
Walgreens #9908 $1,380.81
Mail Order Pharmacy $1,149.21
Lower your drug costs
Estimated Full Cost the Plan Charges Medicare for Your Drugs
Drug Costs During Coverage Levels
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