Page 138 - Cover Letter and Evaluation for Gary Janke

10/8/2018 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 37024
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: 2912465408
and more coverage and star ratings.
Password Date: 10/01/2018
Important Coverage Information

Symbols

Nationwide Coverage
* Estimated

WellCare Value Script Attn: Marketing, PO BOX 31685 Overall Star Rating: [?] Enrollment begins
TAMPA, FL 33631 Coming Soon October 15, 2018
(PDP)

(S4802-147-0) Members:
1-888-550-5252
Organization: WellCare 711 (TTY/TDD)

Plan Type: PDP Non Members:
1-888-293-5151
711 (TTY/TDD)

NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs

Monthly Drug Plan Premium [?] $15.50

Monthly Health Plan Premium [?] N/A

Annual Drug Deductible [?] $415.00
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) [?]
Walgreens #10191 $2,728.90
CVS Pharmacy #17099 $1,715.10
Mail Order Pharmacy $1,400.14
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=S4802&plnid=147&sgmntid=0 1/4