Page 51 - Cover Letter & Evaluation for Michael Novotny

6/9/2018 Your Plan Results
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $20.40 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $244.80 $405 :N/A
3.5 out of 5
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A stars
Annual: N/A $1 - $4, 22% - 35%
MTM Program : Yes

Express Scripts Medicare - Saver (PDP) (S5660-248-0)
Organization: Express Scripts Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $22.50 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $270.00 $405 :N/A
4 out of 5 stars
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A
Annual: N/A $1 - $4, 18% - 43%
MTM Program : Yes

AARP MedicareRx Walgreens (PDP) (S5921-413-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $26.80 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $321.60 $405 :N/A
3.5 out of 5
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A stars
Annual: N/A $0 - $31, 25% - 32%
MTM Program : Yes

Symphonix Value Rx (PDP) (S0522-034-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $27.30 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $327.60 $405 :N/A
3 out of 5 stars
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A
Annual: N/A $1 - $35, 25%
MTM Program : Yes

SilverScript Choice (PDP) (S5601-064-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $28.50 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $342.00 $0 :N/A
4 out of 5 stars
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A
Annual: N/A $3 - $42, 33% - 46%
MTM Program : Yes

Aetna Medicare Rx Saver (PDP) (S5810-066-0)
Organization: Aetna Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:

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