Page 114 - Cover Letter & Evaluation for David Steenburgen

12/7/2017 Your Medicare Health Plan Details

Your Plan Details

Zip Code: 85718
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: 9100980768
and more coverage and star ratings.
Password Date: 12/07/2017
Important Coverage Information

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

Nationwide Coverage
* Estimated

Humana Walmart Rx Plan 500 West Main Street Overall Star Rating: [?] Enroll
Louisville, KY 40202
(PDP)
(S5884-174-0) Members: 3.5 out of 5 stars
1-800-281-6918
Organization: Humana Insurance 711 (TTY/TDD)
Company
Non Members:
Plan Type: PDP 1-800-706-0872
711 (TTY/TDD)

NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs Lowest mail-order
cost of any stand-

Monthly Drug Plan Premium [?] alone plan $20.40

Monthly Health Plan Premium [?] N/A

Annual Drug Deductible [?] $405.00

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) [?]
CVS Pharmacy # $400.80
Costco Pharmacy $367.20
Mail Order Pharmacy $308.80
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=S5884&plnid=174&sgmntid=0 1/3