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9/12/2017 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 90049
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: 0226651648
and more coverage and star ratings.
Password Date: 09/12/2017
Important Coverage Information

Symbols These are the cost and coverage details of the
lowest-cost plan for the drugs that you take.
Nationwide Coverage
* Estimated

Humana Walmart Rx Plan 500 West Main Street Overall Star Rating: [?] Enroll
Louisville, KY 40202
(PDP)
(S5884-178-0) Members: 3 out of 5 stars
1-800-281-6918
Organization: Humana Insurance 711 (TTY/TDD)
Company
Non Members:
Plan Type: 1-800-706-0872
711 (TTY/TDD)

NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs

Monthly Drug Plan Premium [?] $17.00

Monthly Health Plan Premium [?] N/A

Annual Drug Deductible [?] $400.00
Medicare costs at a glance

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

Cost For Rest of Year (based on enrollment today) [?]
CVS Pharmacy $102.60
If your enrollment
Mail Order Pharmacy $67.00
begins October 1
Lower your drug costs

Estimated Full Cost the Plan Charges Medicare for Your Drugs

Drug Costs During Coverage Levels

CVS Pharmacy Mail Order Pharmacy

https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=S5884&plnid=178&sgmntid=0 1/3