Page 78 - Cover letter and evaluation for Thomas Barr

10/16/2017 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 21012
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: 0585196480
and more coverage and star ratings.
Password Date: 10/14/2017
Important Coverage Information

You are now viewing 2018 plan data. View 2017 plan data.
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Nationwide Coverage
* Estimated Enrollment phone
number

EnvisionRxPlus (PDP) 2181 E. Aurora Rd, Suite 201 Overall Star Rating: [?] Enroll
Twinsburg, OH 44087
(S7694-005-0)
3 out of 5 stars
Members:
Organization: EnvisionRx Plus 1-866-250-2005
711 (TTY/TDD)
Plan Type:
Non Members:
1-866-250-2005
711 (TTY/TDD)

NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs

Monthly Drug Plan Premium [?] $12.60

Monthly Health Plan Premium [?] N/A

Annual Drug Deductible [?] $300.00

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) [?]
Broadneck Pharmacy $196.32 This is the cost that
CVS Pharmacy # $163.20 was used in your
Mail Order Pharmacy $151.20 evaluation.
Lower your drug costs

Estimated Full Cost the Plan Charges Medicare for Your Drugs

https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=S7694&plnid=005&sgmntid=0 1/3