Page 48 - SAMPLE
P. 48

2/24/2017                                             Your Plan Results
           Retail           $17.00    Annual Drug Deductible:  All Your Drugs on Formulary:       Enroll
                                      $400                  No
           Pharmacy Status:                                                        3 out of 5 stars
           Standard Cost­             Drug Copay/ Coinsurance:  Drug Restrictions: Yes
           Sharing                    $1 ­ $4, 20% ­ 35%    Lower Your Drug Costs
           Cost as of Today:                                MTM Program [?] : Yes
           $2,969

           Mail Order
           Cost as of Today:
           $3,391

            Notes:
            Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
            Extra Help from Medicare paying your drug costs.













          Return to previous page


























































      https://www.medicare.gov/find­a­plan/results/planresults/plan­list.aspx                                       4/4
   43   44   45   46   47   48   49   50   51   52   53