Page 73 - Cover Letter and Evaluation for Kirk Schmidt

10/31/2017 Your Plan Results
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $20.40 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 3.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $4, 22% - 35% Lower Your Drug Costs
Annual: $3,893 MTM Program : Yes
Mail Order
Annual: $996
WellCare Classic (PDP) (S4802-094-0)
Organization: WellCare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $32.90 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 2.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $32, 25% - 44% Lower Your Drug Costs
Annual: $2,640 MTM Program : Yes
Mail Order
Annual: $1,127
Aetna Medicare Rx Saver (PDP) (S5810-066-0)
Organization: Aetna Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $31.60 Annual Drug Deductible: All Your Drugs on Enroll
$375 Formulary :Yes
Pharmacy Status: 3.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $30, 25% - 35% Lower Your Drug Costs
Annual: $1,090 MTM Program : Yes
Mail Order
Annual: $1,150
WellCare Extra (PDP) (S4802-128-0)
Organization: WellCare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $69.90 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 2.5 out of 5 stars
Preferred Cost- $0 - $32, 33% - 40% Drug Restrictions: Yes
Sharing Lower Your Drug Costs

Annual: $3,033 MTM Program : Yes
Mail Order
Annual: $1,159
SilverScript Plus (PDP) (S5601-065-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $79.70 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 4 out of 5 stars
Preferred Cost- $1 - $35, 33% - 40% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $1,448 MTM Program : Yes

Mail Order
Annual: $1,236

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