Page 24 - Evaluation for John Shartle

11/3/2017 Your Plan Results

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Your Plan Results
Zip Code: 19970
Delaware
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Drug List ID: 6538469152
Your plan results are organized by plan type and are initially sorted by lowest Password Date: 11/03/2017
estimated cost. To view more plans, select View 20 or View All. Select any plan Important Coverage Information
name for details. Compare up to 3 plans by using the checkboxes and selecting
Compare Plans. The costs displayed are estimates; your actual costs may vary.

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

Symbols This is a list of the lowest-cost
plans for your drugs if you get
Nationwide Coverage
mail-order refills. Costs include
premiums, deductible, and co-
Your Current Plan(s) payments.
Original Medicare (H0001-001-0)
Includes Part A (Hospital Insurance) and/or Part B (Medical Insurance) - Excludes Part D Drug
Coverage
Estimated Monthly Deductibles: Health Benefits: [?] Drug Coverage [?] Estimated Overall Star
Annual Drug Premium: [?] and Drug , Drug Restrictions Annual Health Rating: [?]
Costs: [?] [?] Copay [?] / [?] and Drug Costs:
Coinsurance: [?]
[?]
Retail Standard Part B Doctor Choice: Any N/A $13,890 Not Available
Annual: $10,018 Part B: Deductible: $183 Willing Doctor Includes $10,018
$134 for drug costs
Out of Pocket Spending
Limit: Not Applicable

Prescription Drug Plans

21 plans were found in 19970 based on your search criteria. View 10 View 20 View All Because of this

plan's below-
Sort Results By average quality
Magellan Rx Medicare Basic (PDP) (S4607-003-0) rating, we would
Organization: Magellan Rx Medicare not recommend it.
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $31.10 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 2 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $3, 11% - 50% Lower Your Drug Costs
Annual: $2,287 MTM Program : Yes
Mail Order
Annual: $2,023
Express Scripts Medicare - Value (PDP) (S5660-107-0)
Organization: Express Scripts Medicare

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