Page 84 - Cover Letter and Evaluation for Mike Peaseley

11/17/2017 Your Plan Results

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Your Plan Results
Zip Code: 98499
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Drug List ID: 6951340928
Your plan results are organized by plan type and are initially sorted by lowest Password Date: 11/16/2017
estimated cost. To view more plans, select View 20 or View All. Select any plan Important Coverage Information
name for details. Compare up to 3 plans by using the checkboxes and selecting
Compare Plans. The costs displayed are estimates; your actual costs may vary.

You are now viewing 2018 plan data. View 2017 plan data.

Symbols This is a list of the Part D stand-alone
plans that have the lowest costs for
Nationwide Coverage the Rx drugs that you take. The
SilverScript Choice plan has the
Your Current Plan(s) lowest costs for monthly refills and
also for mail-order refills. Costs
Original Medicare (H0001-001-0) include premiums, deductible, and co-
Includes Part A (Hospital Insurance) and/or Part B (Medical Insurance) - Excludes Part D Drug
Coverage payments.
Estimated Monthly Deductibles: Health Benefits: [?] Drug Coverage [?] Estimated Overall Star
Annual Drug Premium: [?] and Drug , Drug Restrictions Annual Health Rating: [?]
Costs: [?] [?] Copay [?] / [?] and Drug Costs:
Coinsurance: [?]
[?]
Retail Standard Part B Doctor Choice: Any N/A $12,920 Not Available
Annual: $9,047 Part B: Deductible: $183 Willing Doctor Includes $9,047
$134 for drug costs
Out of Pocket Spending
Limit: Not Applicable

Prescription Drug Plans

22 plans were found in 98499 based on your search criteria. View 10 View 20 View All

Sort Results By
SilverScript Choice (PDP) (S5601-060-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $30.40 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 4 out of 5 stars
Preferred Cost- $3 - $34, 33% - 34% Drug Restrictions: No
Sharing Lower Your Drug Costs
Annual: $1,245 MTM Program : Yes
Mail Order
Annual: $1,124
EnvisionRxPlus (PDP) (S7694-030-0)
Organization: EnvisionRx Plus

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