Page 52 - Cover Letter & Evaluation for Michael Novotny

6/9/2018 Your Plan Results
Retail $31.60 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $379.20 $375 :N/A
3.5 out of 5
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A stars
Annual: N/A $1 - $30, 25% - 35%
MTM Program : Yes

WellCare Classic (PDP) (S4802-094-0)
Organization: WellCare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $32.90 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $394.80 $405 :N/A
2.5 out of 5
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A stars
Annual: N/A $0 - $32, 25% - 44%
MTM Program : Yes

Humana Preferred Rx Plan (PDP) (S5884-114-0)
Organization: Humana Insurance Company
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $33.80 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $405.60 $405 :N/A
3.5 out of 5
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A stars
Annual: N/A $0 - $1, 20% - 35%
MTM Program : Yes

AARP MedicareRx Saver Plus (PDP) (S5921-376-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $44.20 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $530.40 $405 :N/A
3.5 out of 5
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A stars
Annual: N/A $1 - $32, 25% - 39%
MTM Program : Yes

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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