Page 74 - Cover Letter and Evaluation for Kirk Schmidt

10/31/2017 Your Plan Results
First Health Part D Value Plus (PDP) (S5768-155-0)
Organization: First Health Part D
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $56.30 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3 out of 5 stars
Preferred Cost- $1 - $47, 33% - 50% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $1,276 MTM Program : Yes
Mail Order
Annual: $1,276
Cigna-HealthSpring Rx Secure-Extra (PDP) (S5617-277-0)
Organization: Cigna-HealthSpring Rx
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $64.50 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 2 out of 5 stars
Preferred Cost- $4 - $42, 33% - 50% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $1,446 MTM Program : Yes

Mail Order
Annual: $1,421
Humana Enhanced (PDP) (S5884-030-0)
Organization: Humana Insurance Company
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $82.80 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3.5 out of 5 stars
Preferred Cost- $3 - $42, 33% - 44% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $4,562 MTM Program : Yes
Mail Order
Annual: $1,458
EnvisionRxPlus (PDP) (S7694-032-0)
Organization: EnvisionRx Plus
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $50.00 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 3 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $3, 15% - 27% Lower Your Drug Costs
Annual: $4,201 MTM Program : Yes
Mail Order
Annual: $1,488

Notes:
Your costs may be different depending on your Part B premium, any Part D penalty that may apply, and whether you qualify for
Extra Help from Medicare paying your drug costs.

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