Page 96 - Cover letter and evaluation for Jack Hosier

11/14/2017 Your Medicare Health Plan Details

Your Plan Details

Zip Code: 90803
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs Drug List ID: 9008683968
and more coverage and star ratings.
Password Date: 11/14/2017
Important Coverage Information

Symbols
Coverage details for the Aetna
Nationwide Coverage Medicare Rx Select Plan

* Estimated

Aetna Medicare Rx Select P.O. Box 14088 Overall Star Rating: [?] Enroll
Lexington, KY 40512
(PDP)
(S5810-295-0) Members: 3.5 out of 5 stars
1-877-238-6211
Organization: Aetna Medicare 711 (TTY/TDD) Enrollment phone #
Plan Type: PDP Non Members:
1-855-338-7030
711 (TTY/TDD)

NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs lowest-cost of any
option

Monthly Drug Plan Premium [?] $19.70

Monthly Health Plan Premium [?] N/A

Annual Drug Deductible [?] $405.00
Medicare costs at a glance

Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs

Full Year Cost (based on January enrollment) [?]
Walmart Pharmacy 10-3477 $1,136.40

CVS Pharmacy # $329.40
Lower your drug costs

Estimated Full Cost the Plan Charges Medicare for Your Drugs

Drug Costs During Coverage Levels

https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=S5810&plnid=295&sgmntid=0 1/3