Page 72 - Cover letter and evaluation for Peter Smith

11/27/2017 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 89129
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: 2579428096
and more coverage and star ratings.
Password Date: 11/23/2017
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

Aetna Medicare Choice P.O. Box 14088 Overall Star Rating: [?] Enroll
Lexington, KY 40512
Plan (PPO)
(H5521-055-0) Members: 4 out of 5 stars
1-800-282-5366
Organization: Aetna Medicare 711 (TTY/TDD)
If you enroll in this
Plan Type: Non Members:
1-855-338-7027 plan you would
711 (TTY/TDD) save almost $1,500
by switching to
monthly refills at
Fixed Costs
CVS

Monthly Drug Plan Premium [?] $46.00

Monthly Health Plan Premium [?] $0.00

Annual Drug Deductible [?] $75.00

Medicare costs at a glance
Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs

Full Year Cost (based on January enrollment) [?]
Walgreens #04197 $4,604.02
CVS Pharmacy $4,585.74
Mail Order Pharmacy $6,052.62
Lower your drug costs

https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=H5521&plnid=055&sgmntid=0#plan_drug_cost 1/4