Page 86 - Cover Letter and Evaluation for John

10/9/2018 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 92586
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: 3199691584
and more coverage and star ratings. Password Date: 10/09/2018

Important Coverage Information

You are now viewing 2019 plan data. View 2018 plan data.

Symbols
Nationwide Coverage

* Estimated

Call this number to
enroll. If you decide
to use the Blue
Shield stand-alone
AARP MedicareRx 3315 Central AVE Overall Star Rating: [?] Enrollment begins
Hot Springs, AR 71913 Coming Soon October 15, 2018
Walgreens (PDP) plan for the last two

(S5921-413-0) Members: months of this year,
1-866-870-3470 you can call this
Organization: UnitedHealthcare 711 (TTY/TDD) number during the

Plan Type: PDP Non Members: first week of
1-800-753-8004 December to enroll
711 (TTY/TDD) for the 2019 plan
year.
NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs

Monthly Drug Plan Premium [?] $28.10

Monthly Health Plan Premium [?] N/A

Annual Drug Deductible [?] $415.00
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) [?]
CVS Pharmacy #10434 $3,736.57

Walgreens $3,056.30
Mail Order Pharmacy $3,248.79
Lower your drug costs
Estimated Full Cost the Plan Charges Medicare for Your Drugs

https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=S5921&plnid=413&sgmntid=0 1/4