Page 74 - Cover letter and evaluation for Linda Hosier

11/15/2017 Your Plan Results
Cigna-HealthSpring Rx Secure (PDP) (S5617-158-0)
Organization: Cigna-HealthSpring Rx
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $86.90 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 2 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $34, 25% - 39% Lower Your Drug Costs
Annual: $1,528 MTM Program : Yes
Mail Order
Annual: $1,491
Humana Enhanced (PDP) (S5884-030-0)
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 $82.80 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3.5 out of 5 stars
Standard Cost- $3 - $42, 33% - 44% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $1,904 MTM Program : Yes

Mail Order
Annual: $1,502
Blue Shield Rx Enhanced (PDP) (S2468-004-0)
Organization: Blue Shield of California
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $111.30 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3 out of 5 stars
Preferred Cost- $4 - $40, 25% - 33% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $1,621 MTM Program : Yes
Mail Order
Annual: $1,528
First Health Part D Value Plus (PDP) (S5768-155-0)
Organization: First Health Part D
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $56.30 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3 out of 5 stars
Preferred Cost- $1 - $47, 33% - 50% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $1,533 MTM Program : Yes
Mail Order
Annual: $1,531

Notes:
Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
Extra Help from Medicare paying your drug costs.

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