Page 75 - Evaluation for Dirk Huybrechts

9/12/2017 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 $29.90 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 4 out of 5 stars
Standard Cost- $3 - $47, 33% - 48% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Cost as of Today: MTM Program : Yes
$124

Mail Order
Cost as of Today:
$121
Symphonix Value Rx (PDP) (S0522-034-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $30.60 Annual Drug Deductible: All Your Drugs on Enroll
$400 Formulary :Yes
Pharmacy Status: 2.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $26, 25% - 33% Lower Your Drug Costs
Cost as of Today: MTM Program : Yes
$133
Mail Order
Cost as of Today:
$116
Aetna Medicare Rx Saver (PDP) (S5810-066-0)
Organization: Aetna Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $32.10 Annual Drug Deductible: All Your Drugs on Enroll
$400 Formulary :Yes
Pharmacy Status: 3.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $30, 25% - 38% Lower Your Drug Costs
Cost as of Today: MTM Program : Yes
$134
Mail Order
Cost as of Today:
$102
Humana Preferred Rx Plan (PDP) (S5884-114-0)
Organization: Humana Insurance Company
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $28.20 Annual Drug Deductible: All Your Drugs on Enroll
$400 Formulary :Yes
Pharmacy Status: 3 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $1, 20% - 35% Lower Your Drug Costs
Cost as of Today: MTM Program : Yes
$136
Mail Order
Cost as of Today:
$127
AARP MedicareRx Saver Plus (PDP) (S5921-376-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:

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