Monthly Plan Premium $30.70 
If you receive premium assistance, your plan premium may be 
reduced. 
If you have Part B, you must keep paying your Medicare Part B 
premium. 
Pharmacy (Part D) deductible $505 
Prescription Drug Benefits 
PRESCRIPTION DRUGS 
Important Message About What You Pay for Vaccines 
Our plan covers most Part Dvaccines at no cost to you, no matter what cost-sharing tier it’s on ,even if 
you haven’t paid your deductible .
Important Message About What You Pay for Insulin