Coverage online. 
Catastrophic Coverage 
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and 
through mail order) reach  $7,050 ,you pay the greater of: 
•5% of the cost, or 
•$3.95 copay for generic (including brand drugs treated as generic) and a  $9.85 copayment for all other 
drugs 
Additional Benefits 
Medicare-covered foot care 
(podiatry) $25 copay 
Medicare-covered chiropractic 
services $20 copay 
Medical equipment/ supplies