Page 88 - Cover Letter and Evaluation for Mike Peaseley

11/17/2017 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 98499
Current Coverage: Original Medicare
Current Subsidy: No Extra Help [?]
Select the tabs below for more detailed information about the plan health benefits, drug costs Drug List ID: 6951340928
and more coverage and star ratings.
Password Date: 11/16/2017
Important Coverage Information

You are now viewing 2018 plan data. View 2017 plan data.
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Nationwide Coverage
* Estimated

SilverScript Choice (PDP) P.O. Box 53991 Overall Star Rating: [?] Enroll
Phoenix, AZ 85072
(S5601-060-0)
4 out of 5 stars
Members:
Organization: SilverScript 1-866-235-5660
711 (TTY/TDD)
Plan Type: Call this number to
Non Members: enroll
1-866-552-6106
711 (TTY/TDD)

NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs

Monthly Drug Plan Premium [?] $30.40

Monthly Health Plan Premium [?] N/A
CVS is a preferred
pharmacy in this
Annual Drug Deductible [?] $0.00
plan but Walgreens
Medicare costs at a glance
is not.
Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs

Full Year Cost (based on January enrollment) [?]
Walgreens #3514 $1,432.95
Costs shown include premiums and co-
CVS Pharmacy # $1,244.64
payments (this plan does not have a
Mail Order Pharmacy $1,123.61 deductible)
Lower your drug costs

Estimated Full Cost the Plan Charges Medicare for Your Drugs

https://www.medicare.gov/find-a-plan/results/planresults/plan-details.aspx?cntrctid=S5601&plnid=060&sgmntid=0 1/3