Page 73 - Cover Letter and Evaluation for Mike Peaseley
P. 73
11/17/2017 Your Medicare Health Plan Comparison
Tier 4
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 5
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
Generic drugs Generic drugs Generic drugs
Greater of 5% or $3.35 copay Not Available Greater of 5% or $3.35 copay Not Available
Brand-name drugs Brand-name drugs Brand-name drugs
Greater of 5% or $8.35 copay Not Available Greater of 5% or $8.35 copay Not Available
1 When your annual out-of-pocket costs exceed $5,000
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