Page 34 - Cover Letter and Evaluation for Anne Parlin

10/11/2017 Your Medicare Health Plan Details

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Your Plan Details

Zip Code: 20817
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: 1039925088
and more coverage and star ratings.
Maryland Password Date: 10/10/2017
Important Coverage Information

You are now viewing 2018 plan data. View 2017 plan data.
This is the plan you are currently
Symbols
enrolled in and its estimated costs
Nationwide Coverage for 2018. Costs include premiums,
* Estimated deductible, and co-payments. In
this plan if you were to get
monthly refills at Walmart, you
would pay $564, and if you get
mail-order refills you would pay
$540.

Humana Walmart Rx Plan 500 West Main Street Overall Star Rating: [?] Enrollment begins
Louisville, KY 40202 October 15, 2017
(PDP)
(S5884-151-0) Members: 3.5 out of 5 stars
1-800-281-6918
Organization: Humana Insurance 711 (TTY/TDD)
Company
Non Members:
Plan Type: 1-800-706-0872
711 (TTY/TDD)

NOTE: Health Plan Benefits are based on Original Medicare

Fixed Costs

Monthly Drug Plan Premium [?] $20.40

Monthly Health Plan Premium [?] N/A
Annual Drug Deductible [?] $405.00

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 $595.20
Walmart Pharmacy 10-5936 $564.00
Mail Order Pharmacy $540.00
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=S5884&plnid=151&sgmntid=0 1/3