Page 118 - Cover Letter & Evaluation for David Steenburgen

12/7/2017 Your Medicare Health Plan Details

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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

Symbols

Nationwide Coverage
* Estimated

Aetna Medicare Rx Select P.O. Box 14088 Overall Star Rating: [?] Enroll
Lexington, KY 40512
(PDP)
(S5810-294-0) Members: 3.5 out of 5 stars
1-877-238-6211
Organization: Aetna Medicare 711 (TTY/TDD) enrollment phone
number
Plan Type: Non Members:
1-855-338-7030
711 (TTY/TDD)
Lowest retail cost
NOTE: Health Plan Benefits are based on Original Medicare and lowest overall
cost of any plan.
Fixed Costs Costs include
premiums,

Monthly Drug Plan Premium [?] $12.70
deductible, and co-
Monthly Health Plan Premium [?] payments.
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) [?]
Costco Pharmacy $152.40
CVS Pharmacy # $152.40
Lower your drug costs

Estimated Full Cost the Plan Charges Medicare for Your Drugs

Drug Costs During Coverage Levels

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