Page 116 - Cover Letter and Evaluation for Anne Ellzey

11/8/2017 Your Plan Results
Cigna-HealthSpring Rx Secure-Extra (PDP) (S5617-267-0)
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 $54.60 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :No
Pharmacy Status: Drug Copay/ Coinsurance: 2 out of 5 stars
Standard Cost- $4 - $42, 33% - 50% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $7,127 MTM Program : Yes
Mail Order
Annual: $7,037
SilverScript Choice (PDP) (S5601-044-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $23.50 Annual Drug Deductible: $0 All Your Drugs on Enroll
Formulary :No
Pharmacy Status: Drug Copay/ Coinsurance: 4 out of 5 stars
Preferred Cost- $9 - $46, 33% - 49% Drug Restrictions: Yes
Sharing Lower Your Drug Costs
Annual: $7,338 MTM Program : Yes

Mail Order
Annual: $7,378
Symphonix Value Rx (PDP) (S0522-039-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $23.30 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :No
Pharmacy Status: 3 out of 5 stars
Preferred Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $1 - $35, 25% Lower Your Drug Costs
Annual: $7,580 MTM Program : Yes
Mail Order
Annual: $7,455
AARP MedicareRx Walgreens (PDP) (S5921-403-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Copay [?] / Coinsurance: Restrictions [?] and Other Rating: [?]
[?] [?] Programs:
Retail $26.70 Annual Drug Deductible: All Your Drugs on Enroll
$405 Formulary :No
Pharmacy Status: 3.5 out of 5 stars
Standard Cost- Drug Copay/ Coinsurance: Drug Restrictions: Yes
Sharing $0 - $31, 25% - 32% Lower Your Drug Costs
Annual: $7,947 MTM Program : Yes
Mail Order
Annual: $7,564

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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