Page 94 - Appendices for Eric Hartman
P. 94
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Aetna Medicare
SilverScript SmartSaver (PDP)
Call this number to
Plan type: Drug plan (Part D) enroll
Plan ID: S5601-207-0
Plan website Non-members: 1-833-526-2445 Members: 1-866-235-5660
What you'll pay $4.50 monthly premium x 12 months =$54 + $80.04
in co-payments - $134.04 in annual estimated costs
Total monthly Retail pharmacy: 2023 estimated total Mail order pharmacy: 2023 estimated total
premium drug costs drug costs
$4.50 $85.56 $80.04
Covers 4 of 4 drugs Covers 4 of 4 drugs
Overview
PREMIUMS
Total monthly premium $4.50
DEDUCTIBLES
The amount you must pay each year before your plan starts to pay for covered services or drugs.
Drug deductible $505.00
