Page 72 - Cover Letter and Evaluation for Mike Peaseley
P. 72
11/17/2017 Your Medicare Health Plan Comparison
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 All drugs may not be offered with additional gap coverage, for all other drugs, you pay 44% for generic drugs and 35% for brand-
name drugs.
2 After the total drug costs paid by you and the plan reach $3,750, up to the out-of-pocket threshold of $5,000
Catastrophic Coverage Phase Aetna Medicare Select Plan (PPO) 1
Aetna Medicare Choice Plan (PPO) 1
Tier 1
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
Tier 2
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
Tier 3
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
https://www.medicare.gov/find-a-plan/results/planresults/plan-compare.aspx#plan_benefits 8/9
