Page 25 - Evaluation for John Shartle

11/3/2017 Your Plan Results
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $26.00 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 4 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $18, 25% - 47% Lower Your Drug Costs
See below to
Annual: $2,969 MTM Program : Yes
compare these
Mail Order costs to those if
Annual: $2,027
you remain in your
SilverScript Choice (PDP) (S5601-010-0)
Organization: SilverScript current plan. You'll
save an estimated
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
$435 by switching
[?] [?] Programs:
to this plan.
Retail $29.50 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 4 out of 5 stars
Preferred Cost- $9 - $46, 33% - 49% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $2,169 MTM Program : Yes
Mail Order
Annual: $2,056
WellCare Extra (PDP) (S4802-102-0)
Organization: WellCare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $64.10 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 2.5 out of 5 stars
Preferred Cost- $0 - $36, 33% - 35% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $3,480 MTM Program : Yes
Mail Order
Annual: $2,185
WellCare Classic (PDP) (S4802-079-0)
Organization: WellCare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $29.90 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 2.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $37, 25% - 48% Lower Your Drug Costs

Annual: $3,108 MTM Program : Yes
Mail Order
Annual: $2,192
AARP MedicareRx Saver Plus (PDP) (S5921-350-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $28.90 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 3.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $34, 25% - 41% Lower Your Drug Costs
Annual: $3,074 MTM Program : Yes

Mail Order
Annual: $2,238

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