Page 14 - Cover Letter and Medicare Evaluation for Dorothy Smith

Your Prescription Drug Costs

These costs are for your prescription drugs and are based on the dosages and monthly quantities that
you use. These costs include premiums, deductible, and co-payments.

Pharmacy Information

Client's pharmacy: When you need a retail prescription filled or refilled, you will
usually get the lowest prices at one of your plan's preferred
Rite Aid pharmacies. Some plans do not have preferred pharmacies.

Is Rite Aid a preferred pharmacy in the following plans' networks?

SilverScript SmartSaver Prescription No, but it is in this plan's pharmacy network. CVS is a
Drug Plan (PDP) preferred pharmacy in this plan.

No, but it is in this plan's pharmacy network. It's possible that
Humana Gold Plus HMO-POS Plan
this plan does not have preferred pharmacies.
AARP Medicare Advantage Choice Plan 1 No, but it is in this plan's pharmacy network. It's possible that
(PPO) this plan does not have preferred pharmacies.

y g

The lowest-cost Part D stand-alone plan for your drugs
SilverScript SmartSaver
Prescription Drug Plan (PDP)
To enroll in a plan, call its toll-free
number (833) 526-2445
Est. annual costs for monthly refills at $286
Rite Aid

Est. annual costs for mail-order refills NA

This plan's Medicare quality rating 3.5 out of 5 stars

Medicare Advantage plans' costs for your drugs

These two Medicare Advantage plans Humana Gold Plus HMO-POS AARP Medicare Advantage
include prescription drug and medical Plan Choice Plan 1 (PPO)
coverage (800) 833-2364 (800) 555-5757
Est. annual costs for monthly refills at $0 $0
Rite Aid
Est. annual costs for mail-order refills $0 $0

This plan's Medicare quality rating 4.5 out of 5 stars 4 out of 5 stars

4