Page 12 - Cover Letter and Medicare Evaluation for Donald Pender

Your Prescription Drug Costs

These costs are for your prescription drugs and are based on the dosages and monthly quantities that
you use. These costs include premiums, deductible, and co-payments.

Pharmacy Information

Client's pharmacy: When you need a retail prescription filled or refilled, you will
usually get the lowest prices at one of your plan's preferred
Rite Aid pharmacies (some plans do not have preferred pharmacies).

Which pharmacies are the plans' preferred pharmacies

Humana Walmart Value Rx Prescription Rite Aid is in this plan's pharmacy network but is not a
Drug plan preferred pharmacy (Walmart is).

Rite Aid, CVS, and Walmart are all standard pharmacies in this
Platinum Advantage HMO Plan
plan

Rite Aid is not a preferred pharmacy in this plan, but CVS and
Blue Shield 65 Plus Advantage HMO Plan
Walmart are

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The lowest-cost Part D stand-alone plan for your drugs

Humana Walmart Value Rx
To enroll in a plan, call its toll-free
number Prescription Drug plan
(800) 706-0872
Est. annual cost at Rite Aid (including
premiums) $401

Mail-order refills $399

This plan's Medicare quality rating 4 out of 5 stars

Medicare Advantage plans' costs for your drugs

These two Medicare Advantage plans
include prescription drug and medical Platinum Advantage HMO Blue Shield 65 Plus Advantage
HMO Plan
Plan
coverage
Est. annual cost at Rite Aid (including $0 $144
premiums)

Mail-order refills $0 $30

This plan's Medicare quality rating 4 out of 5 stars 4 out of 5 stars

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