Page 32 - Cover letter and evaluation for Peter Smith
P. 32
11/27/2017 Your Medicare Health Plan Details
Catastrophic Coverage Phase
Tier 1 Preferred Generic
$0.00 copay
Tier 2 Generic
$3.35 copay or 5% (whichever costs more)
Tier 3 Preferred Brand
$8.35 copay or 5% (whichever costs more)
Tier 4 Non-Preferred Drug
$8.35 copay or 5% (whichever costs more)
Tier 5 Specialty Tier
$8.35 copay or 5% (whichever costs more)
Tier 6 Select Care Drugs
$0.00 copay
When your annual out-of-pocket costs exceed $5,000
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