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2013 Stand-Alone Plans That Offer a $0 Premium with Full Low-Income Subsidy (LIS)

|Company Name |Plan Name |Monthly Drug Premium (Medicare will |Annual Drug Deductible |

| | |pay this premium for individuals with |(Medicare will pay the deductible for |

| | |full LIS) |individuals with full LIS) |

|Aetna Medicare |Aetna CVS/pharmacy Prescription Drug Plan |$29.30 |$325 |

| |(S5810-051) | | |

|CIGNA Medicare Rx |CIGNA Medicare Rx Plan One |$31.30 |$325 |

| |(S5617-224) | | |

|EnvisionRx Plus |EnvisionRxPlus Silver |$29.70 |$325 |

| |(S7694-017) | | |

|HealthMarkets Medicare |Reader’s Digest Value Rx |$32.00 |$325 |

| |(S0128-018) | | |

|HealthSpring Prescription Drug Plan |HealthSpring Prescription Drug Plan-Reg 17 |$32.90 |$325 |

| |(S5932-016) | | |

|Humana Insurance Company |Humana Walmart-Preferred Rx Plan |$18.50 |$325 |

| |(S5884-107) | | |

|SilverScript |SilverScript Basic (called CVS Caremark Value in |$31.20 |$325 |

| |2012) | | |

| |(S5601-034) | | |

|SmartD Rx |SmartD Rx Saver |$29.60 |$325 |

| |(S0064-017) | | |

|United American Insurance Company |United American – Select |$30.00 |$325 |

| |(S5755-088) | | |

|United Healthcare |AARP MedicareRx Saver Plus |$15.00 |$325 |

| |(S5921-362) | | |

PDP plans that will no longer offer a $0 premium with full LIS in 2013

• Community CCRx Basic (S5803-086) (plan discontinued in 2013)

• First Health Part D Premier (S5768-042)

• WellCare Classic (S5967-154)

New PDP plans that will offer a $0 premium with full LIS in 2013

• Readers Digest Value Rx (S0128-018)

• Smart D Rx Saver (S0064-017)

2012 Low-Income Subsidy

Income and Asset Limits (as of October 2012)

Full Low-Income Subsidy

| |Individual |Couple |

|Income |$15,080 annually |$20,426 annually |

| |($1,257 monthly) |($1,702 monthly) |

|Asset |$8,440* |$13,410* |

Partial Low-Income Subsidy

| |Individual |Couple |

|Income |$16,755 annually |$22,695 annually |

| |($1,396 monthly) |($1,891 monthly) |

|Asset |$13,070* |$26,120* |

* Resource limits include $1,500 per person burial expenses

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