Page 88 - Evaluation for 2018

12/23/2017 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 99005
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: 1321108544
and more coverage and star ratings.
Password Date: 12/23/2017
Important Coverage Information

You are now viewing 2018 plan data. View 2017 plan data.
Symbols

Nationwide Coverage
* Estimated

Humana Walmart Rx Plan 500 West Main Street Overall Star Rating: [?] Enroll
Louisville, KY 40202
(PDP)
(S5884-176-0) Members: 3.5 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 [?] $20.40

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) [?]
CVS Pharmacy # $640.80
Walmart Pharmacy 10-2865 $352.80
Estimated annual
Mail Order Pharmacy $308.80 costs include
Lower your drug costs premiums,
deductible, and co-
Estimated Full Cost the Plan Charges Medicare for Your Drugs
payments.
https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=S5884&plnid=176&sgmntid=0 1/3