Page 80 - Cover Letter and Evaluation for Kirk Schmidt

10/31/2017 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 95076
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: 5773524704
and more coverage and star ratings.
Password Date: 10/22/2017
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
(S5601-064-0)
4 out of 5 stars
Members:
Organization: SilverScript 1-866-235-5660
711 (TTY/TDD)
Plan Type:
Non Members:
1-866-552-6106 Estimated costs
711 (TTY/TDD)
include premiums
NOTE: Health Plan Benefits are based on Original Medicare and co-payments.

Fixed Costs

Monthly Drug Plan Premium [?] $28.50

Monthly Health Plan Premium [?] N/A

Annual Drug Deductible [?] $0.00

Medicare costs at a glance

Estimate of What YOU Will Pay for Drug Plan Premium and Drug Costs

Full Year Cost (based on January enrollment) [?]
CVS Pharmacy # $1,038.00
Walgreens $1,230.00
Mail Order Pharmacy $892.00
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=064&sgmntid=0 1/3