The drug costs displayed above are estimates based on the drugs you entered and assuming you will fill your prescription at a preferred pharmacy. These estimates may vary from the actual cost you pay based on the specific quantity, strength, and/or dosage of each medication, the packaging of the medicine, the order in which you purchase your prescriptions, and the pharmacy you use. Drug pricing also changes over time.

Benefits, formulary, pharmacy network, premium and/or copayments/ co-insurance may change on January 1, 2013. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. You must continue to pay your Medicare Part B premium. Limitations, copayments and restrictions may apply. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; Your State Medicaid Office. You may enroll in the plan only during specific times of the year. Contact the plan for more information. You must have Part A and Part B to enroll in the plan. We have formed a network of pharmacies. To receive plan prescription drug benefits, you must use a network pharmacy, except in non-routine circumstances, and quantity limitations and restrictions may apply. For PPO plans: With the exception of emergencies or urgent care, it may cost more to get care from out-of- network providers. For HMO plans: You must receive all routine care from plan providers. You must use plan providers except in emergency or urgent care situations. If you obtain routine care from out-of-network providers neither Original Medicare nor the plan will be responsible for the costs. For PFFS plans: A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your provider is not required to agree to accept the plan’s terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your provider does not agree to accept our terms and conditions of payment, they may choose not to provide health care services to you, except in emergencies. If this happens, you will need to find another provider that will accept our terms and conditions of payment. Providers can find the plan’s terms and conditions of payment on our website at: www.TodaysOptions.com. For Network PFFS plans: A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. We have network providers (that is, providers who have signed contracts with our plan) for all services covered under Original Medicare. These providers have already agreed to see members of our plan. If your provider is not one of our network providers, then the provider is not required to agree to accept the plan’s terms and conditions, of payment, they may choose not to provide health care services to you, except in emergencies. If this happens, you will need to find another provider that will accept our terms and conditions of payment. Providers can find the plan’s terms and conditions of payment on our website at: www.TodaysOptions.com.