Page 88 - Cover Letter & Evaluation for Isaac Kapon

10/5/2017 Your Medicare Health Plan Comparison

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Your Plan Comparison
Zip Code: 89014
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits,
drug costs and coverage and star ratings. Important Coverage Information

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* Estimated numbers to enroll
effective 11-1.

Express Scripts Medicare - Saver (PDP) Humana Walmart Rx Plan (PDP)
(S5660-245) Plan Type: (S5884-175) Plan Type:
Organization: Express Scripts Medicare Organization: Humana Insurance Company
Members: 1-800-758-4574 Members: 1-800-281-6918
1-800-716-3231(TTY/TDD) 711(TTY/TDD)
Non Members: 1-866-477-5704 Non Members: 1-800-706-0872
1-800-716-3231(TTY/TDD) 711(TTY/TDD)
Coverage: Provides drug coverage only. Coverage: Provides drug coverage only.
NOTE: Health Plan Benefits are based on Original Medicare NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs

Monthly Health Plan Premium N/A Monthly Health Plan Premium N/A

Monthly Drug Plan Premium $22.60 Monthly Drug Plan Premium $20.40
Estimated Costs

You have not entered any drugs. The costs below are based on You have not entered any drugs. The costs below are based on
estimated averages. To get specific costs for the drugs you take, estimated averages. To get specific costs for the drugs you take,
Enter drugs. Enter drugs.
Average annual drug costs: [?] $1,819.20 Average annual drug costs: [?] $1,876.80

This does not include any health costs you may have. This does not include any health costs you may have.
Medicare costs at a glance Medicare costs at a glance

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