Page 90 - Cover Letter and Evaluation for Debbie Workman
P. 90

12/13/2017                                       Your Medicare Health Plan Details








         Your Plan Details

                                                                          Zip Code:  99206
                                                                          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:  2065979904
         and more coverage and star ratings.
                                                                          Password Date:  12/13/2017
                                                                          Important Coverage Information

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

              Nationwide Coverage
           * Estimated










            EnvisionRxPlus (PDP)             2181 E. Aurora Rd, Suite 201   Overall Star Rating:  [?]  Enroll
                                             Twinsburg, OH 44087
            (S7694-030-0)
                                                                         3 out of 5 stars
                                             Members:
            Organization: EnvisionRx Plus    1-866-250-2005
                                             711 (TTY/TDD)
            Plan Type: PDP
                                                                           This is the lowest cost Part
                                             Non Members:
                                             1-888-377-1439                D stand-alone plan for the
                                             711 (TTY/TDD)                 drugs that you take if you
                                                                           get mail-order refills.
            NOTE: Health Plan Benefits are based on Original Medicare


               Fixed Costs

            Monthly Drug Plan Premium [?]                                                       $12.60

            Monthly Health Plan Premium [?]                                                     N/A

            Annual Drug Deductible [?]                                                          $300.00
            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) [?]
            Walgreens #7846                $552.60
            CVS Pharmacy #                 $318.72
            Mail Order Pharmacy            $223.20
          Lower your drug costs

               Estimated Full Cost the Plan Charges Medicare for Your Drugs



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