Page 69 - Cover Letter and Evaluation for Mike Peaseley
P. 69
11/17/2017 Your Medicare Health Plan Comparison
Tier 2 2 (Generic) 2 (Generic)
Preferred Retail Preferred Retail
1-Month: $5.00 copay 1-Month: $5.00 copay
3-Month: $15.00 copay 3-Month: $15.00 copay
All: Not Available All: Not Available
Standard Retail Standard Retail
1-Month: $15.00 copay 1-Month: $15.00 copay
3-Month: $45.00 copay 3-Month: $45.00 copay
All: Not Available All: Not Available
Preferred Mail Order Preferred Mail Order
1-Month: $5.00 copay 1-Month: $5.00 copay
3-Month: $10.00 copay 3-Month: $10.00 copay
All: Not Available All: Not Available
Standard Mail Order Standard Mail Order
1-Month: $15.00 copay 1-Month: $15.00 copay
3-Month: $45.00 copay 3-Month: $45.00 copay
All: Not Available All: Not Available
Tier 3 3 (Preferred Brand) 3 (Preferred Brand)
Preferred Retail Preferred Retail
1-Month: $42.00 copay 1-Month: $42.00 copay
3-Month: $126.00 copay 3-Month: $126.00 copay
All: Not Available All: Not Available
Standard Retail Standard Retail
1-Month: $47.00 copay 1-Month: $47.00 copay
3-Month: $141.00 copay 3-Month: $141.00 copay
All: Not Available All: Not Available
Preferred Mail Order Preferred Mail Order
1-Month: $42.00 copay 1-Month: $42.00 copay
3-Month: $121.00 copay 3-Month: $121.00 copay
All: Not Available All: Not Available
Standard Mail Order Standard Mail Order
1-Month: $47.00 copay 1-Month: $47.00 copay
3-Month: $141.00 copay 3-Month: $141.00 copay
All: Not Available All: Not Available
Tier 4 4 (Non-Preferred Drug) 4 (Non-Preferred Drug)
Preferred Retail Preferred Retail
1-Month: $100.00 copay 1-Month: $100.00 copay
3-Month: $300.00 copay 3-Month: $300.00 copay
All: Not Available All: Not Available
Standard Retail Standard Retail
1-Month: $100.00 copay 1-Month: $100.00 copay
3-Month: $300.00 copay 3-Month: $300.00 copay
All: Not Available All: Not Available
Preferred Mail Order Preferred Mail Order
1-Month: $100.00 copay 1-Month: $100.00 copay
3-Month: $300.00 copay 3-Month: $300.00 copay
All: Not Available All: Not Available
Standard Mail Order Standard Mail Order
1-Month: $100.00 copay 1-Month: $100.00 copay
3-Month: $300.00 copay 3-Month: $300.00 copay
All: Not Available All: Not Available
Tier 5 5 (Specialty Tier) 5 (Specialty Tier)
Preferred Retail Preferred Retail
1-Month: 33% 1-Month: 33%
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Standard Retail Standard Retail
1-Month: 33% 1-Month: 33%
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Preferred Mail Order Preferred Mail Order
1-Month: 33% 1-Month: 33%
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Standard Mail Order Standard Mail Order
1-Month: 33% 1-Month: 33%
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
https://www.medicare.gov/find-a-plan/results/planresults/plan-compare.aspx#plan_benefits 5/9
