Page 115 - Cover Letter and Evaluation for Anne Ellzey

11/8/2017 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 $56.20 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: $4,745 MTM Program : Yes
Mail Order
Annual: $4,921
Blue Cross MedicareRx Value (PDP) (S5715-005-0)
Organization: HISC - Blue Cross Blue Shield of IL, NM, OK, TX
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $87.30 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :Yes
Pharmacy Status: 3.5 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $42, 25% - 40% Lower Your Drug Costs
Annual: $5,225 MTM Program : Yes
Mail Order
Annual: $5,002
Magellan Rx Medicare Basic (PDP) (S4607-019-0)
Organization: Magellan Rx Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $75.60 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :No
Pharmacy Status: 2 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $4, 13% - 50% Lower Your Drug Costs
Annual: $5,269 MTM Program : Yes
Mail Order
Annual: $5,288
Blue Cross MedicareRx Plus (PDP) (S5715-006-0)
Organization: HISC - Blue Cross Blue Shield of IL, NM, OK, TX
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $197.10 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :Yes
Pharmacy Status: Drug Copay/ Coinsurance: 3.5 out of 5 stars
Preferred Cost- $0 - $30, 33% - 35% Drug Restrictions: Yes
Sharing Lower Your Drug Costs

Annual: $6,492 MTM Program : Yes
Mail Order
Annual: $6,070
Cigna-HealthSpring Rx Secure (PDP) (S5617-108-0)
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 $23.70 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :No
Pharmacy Status: 2 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $2 - $35, 25% - 41% Lower Your Drug Costs
Annual: $6,876 MTM Program : Yes

Mail Order
Annual: $6,637

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