Page 14 - Cover Letter & Evaluation for Isaac Kapon
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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
When you need a retail prescription filled or refilled, you will
Client's pharmacy:
usually get the lowest prices at one of your plan's preferred
pharmacies. Some plans, though, do not have preferred
CVS, Walgreens, or Walmart
pharmacies.
Are CVS, Costco, and Walgreens preferried pharmacies in the following plans' pharmacy networks?
Humana Walmart Rx Plan Walmart is plan's only preferred pharmacy
Express Scripts Medicare Saver CVS is a preferred pharmacy in this plan
Humana Choice PPO Plan Costco, CVS and Walgreens are network pharmacies
Aetna Medicare Choice PPO Plan Costco, CVS and Walgreens are network pharmacies
Estimated retail costs for your drugs
The two lowest-cost Part D stand-alone plans for your drugs
Lowest cost stand- Express Scripts Medicare Saver
alone drug plan Humana Walmart Rx Plan Plan
To enroll in a plan, call its toll-free
number 866-477-5704 800-706-0872
Annual premiums $245 $271
Est. annual costs with mail-order refills NA NA
This plan's Medicare quality rating 3 stars 4 stars
Medicare Advantage plans' costs for your drugs
These two Medicare Advantage plans Humana Choice PPO Plan (H5216-
include prescription drug and medical 141) Aetna Medicare Choice PPO Plan
coverage
Annual prem9iums $0 $552
Est. annual costs with mail-order refills NA NA
This plan's Medicare quality rating 3.5 stars 4 stars
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