Page 80 - Evaluation with Cover Letter for Henry Rose

9/16/2017 Your Plan Results

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Your Plan Results
Zip Code: 22202
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Drug List ID: 9912552448
Your plan results are organized by plan type and are initially sorted by lowest Password Date: 09/16/2017
estimated cost. To view more plans, select View 20 or View All. Select any plan Important Coverage Information
name for details. Compare up to 3 plans by using the checkboxes and selecting
Compare Plans. The costs displayed are estimates; your actual costs may vary.

Symbols
This is a list of Arlington County's 10 lowest-cost
Nationwide Coverage Part D stand-alone plans for the drugs that you
take. This list is sorted by the plans' mail-order
costs for the rest of the year, assuming you enroll
Your Current Plan(s)
October 1. The lowest-cost plans are listed first.
Original Medicare (H0001-001-0)
Includes Part A (Hospital Insurance) and/or Part B (Medical Insurance) - Excludes Part D Drug
Coverage
Estimated Monthly Deductibles: Health Benefits: [?] Drug Coverage [?] Estimated Overall Star
Annual Drug Premium: [?] and Drug , Drug Restrictions Annual Health Rating: [?]
Costs: [?] [?] Copay [?] / [?] and Drug Costs:
Coinsurance: [?]
[?]
Retail Standard Part B Doctor Choice: Any N/A $7,410 Not Available
Cost as of Today: Part B: Deductible: $183 Willing Doctor Includes $3,988
$997 $109 for drug costs
Out of Pocket Spending
Limit: Not Applicable

Prescription Drug Plans

23 plans were found in 22202 based on your search criteria. View 10 View 20 View All

Estimated cost for
Sort Results By
the last 3 months of
Humana Walmart Rx Plan (PDP) (S5884-153-0) 2017 is $75 for
Organization: Humana Insurance Company
mail-order refills.
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Costs include
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs: premiums,
Retail $17.00 Annual Drug Deductible: All Your Drugs on deductible, and co- Enroll
$400 Formulary :Yes
3 out of 5 stars
Pharmacy Status: payments. For the
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
entire 2017 plan
Sharing $1 - $4, 20% - 35% Lower Your Drug Costs
year, your cost
Cost as of Today: MTM Program : Yes
$153 would be $300.
Mail Order
Cost as of Today:
$75
AARP MedicareRx Walgreens (PDP) (S0522-052-0)
Organization: UnitedHealthcare

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