Page 76 - Cover letter and evaluation for Thomas Barr

10/14/2017 Your Plan Results
AARP MedicareRx Walgreens (PDP) (S5921-387-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $26.70 Annual Drug Deductible: All Your Drugs on Enrollment begins
$405 Formulary :Yes October 15, 2017
Pharmacy Status: 3.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $31, 25% - 32% Lower Your Drug Costs
Annual: $359 MTM Program : Yes
Mail Order
Annual: $320
AARP MedicareRx Saver Plus (PDP) (S5921-350-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $28.90 Annual Drug Deductible: All Your Drugs on Enrollment begins
$405 Formulary :Yes October 15, 2017
Pharmacy Status: 3.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $34, 25% - 41% Lower Your Drug Costs
Annual: $368 MTM Program : Yes

Mail Order
Annual: $371
SilverScript Choice (PDP) (S5601-010-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $29.50 Annual Drug Deductible: $0 All Your Drugs on Enrollment begins
Formulary :Yes October 15, 2017
Pharmacy Status: Drug Copay/ Coinsurance: 4 out of 5 stars
Preferred Cost- $9 - $46, 33% - 49% Drug Restrictions: No
Sharing Lower Your Drug Costs
Annual: $370 MTM Program : Yes
Mail Order
Annual: $354
Aetna Medicare Rx Saver (PDP) (S5810-039-0)
Organization: Aetna Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $30.30 Annual Drug Deductible: All Your Drugs on Enrollment begins
$350 Formulary :Yes October 15, 2017
Pharmacy Status: 3.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $30, 26% - 35% Lower Your Drug Costs
Annual: $376 MTM Program : Yes
Mail Order
Annual: $374

Notes:
Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
Extra Help from Medicare paying your drug costs.

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