Page 110 - Cover Letter & Evaluation for David Steenburgen

12/7/2017 Your Plan Results

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Your Plan Results
Zip Code: 85718
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Drug List ID: 9100980768
Your plan results are organized by plan type and are initially sorted by lowest Password Date: 12/07/2017
estimated cost. To view more plans, select View 20 or View All. Select any plan Important Coverage Information
name for details. Compare up to 3 plans by using the checkboxes and selecting
Compare Plans. The costs displayed are estimates; your actual costs may vary.

You are now viewing 2018 plan data. View 2017 plan data.

Symbols This is a list of the 10 lowest-cost Part
D stand-alone plans for the drugs that
Nationwide Coverage
you take if you get mail-order refills.
The lowest-cost plans are listed first.
Your Current Plan(s) Costs include premiums, deductible,
and co-payments.
Original Medicare (H0001-001-0)
Includes Part A (Hospital Insurance) and/or Part B (Medical Insurance) - Excludes Part D Drug
Coverage
Estimated Monthly Deductibles: Health Benefits: [?] Drug Coverage [?] Estimated Overall Star
Annual Drug Premium: [?] and Drug , Drug Restrictions Annual Health Rating: [?]
Costs: [?] [?] Copay [?] / [?] and Drug Costs:
Coinsurance: [?]
[?]
Retail Standard Part B Doctor Choice: Any N/A $4,880 Not Available
Annual: Part B: Deductible: $183 Willing Doctor Includes $1,008
$134 for drug costs
Out of Pocket Spending
Limit: Not Applicable

Prescription Drug Plans Lowest annual
mail-order cost
23 plans were found in 85718 based on your search criteria. View 10 View 20 View All

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Humana Walmart Rx Plan (PDP) (S5884-174-0)
Organization: Humana Insurance Company
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $20.40 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 3.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: No
Sharing $1 - $4, 25% - 35% Lower Your Drug Costs
Annual: MTM Program : Yes
Mail Order This plan has a
Annual: $309
substandard quality
WellCare Classic (PDP) (S4802-092-0)
Organization: WellCare rating and is at risk
of being placed on
probation.
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