Page 70 - Cover Letter and Evaluation for Mike Peaseley
P. 70
11/17/2017 Your Medicare Health Plan Comparison
Generic drugs
Preferred Retail Preferred Retail
1-Month: Not Available 1-Month: Not Available
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Standard Retail Standard Retail
1-Month: Not Available 1-Month: Not Available
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Preferred Mail Order Preferred Mail Order
1-Month: Not Available 1-Month: Not Available
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Standard Mail Order Standard Mail Order
1-Month: Not Available 1-Month: Not Available
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Not Available Not Available
Brand-name drugs
Preferred Retail Preferred Retail
1-Month: Not Available 1-Month: Not Available
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Standard Retail Standard Retail
1-Month: Not Available 1-Month: Not Available
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Preferred Mail Order Preferred Mail Order
1-Month: Not Available 1-Month: Not Available
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Standard Mail Order Standard Mail Order
1-Month: Not Available 1-Month: Not Available
3-Month: Not Available 3-Month: Not Available
All: Not Available All: Not Available
Not Available Not Available
1 After you pay your deductible, if applicable, up to the initial coverage limit of $3,750
Coverage Gap Phase Aetna Medicare Choice Plan (PPO) 1,2 Aetna Medicare Select Plan (PPO) 1,2
Tier 1 1 (Preferred Generic) 1 (Preferred Generic)
Preferred Retail Preferred Retail
1-Month: $0.00 copay 1-Month: $0.00 copay
3-Month: $0.00 copay 3-Month: $0.00 copay
All: Not Available All: Not Available
Standard Retail Standard Retail
1-Month: $10.00 copay 1-Month: $10.00 copay
3-Month: $30.00 copay 3-Month: $30.00 copay
All: Not Available All: Not Available
Preferred Mail Order Preferred Mail Order
1-Month: $0.00 copay 1-Month: $0.00 copay
3-Month: $0.00 copay 3-Month: $0.00 copay
All: Not Available All: Not Available
Standard Mail Order Standard Mail Order
1-Month: $10.00 copay 1-Month: $10.00 copay
3-Month: $30.00 copay 3-Month: $30.00 copay
All: Not Available All: Not Available
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
https://www.medicare.gov/find-a-plan/results/planresults/plan-compare.aspx#plan_benefits 6/9
