SilverPine 2027 changes

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PO Box 61180
Nashville, TN 37206

SilverPine Rx (888) 555-0137
silverpinerx.example

Annual Notice of Changes for 2027
September 22, 2026

LORRAINE M PRUITT
2217 LARKMOOR LANE NW
CLEVELAND TN 37312

Member ID: SPR40981775 Plan: SilverPine Rx Value (Medicare prescription drug plan)

You are enrolled in SilverPine Rx Value. Next year the plan's costs and coverage will change.
You do not have to do anything to stay in the plan. If you want a different plan, you can change
between October 15 and December 7, 2026. A change takes effect on January 1, 2027.

What changes on January 1, 2027

2026 2027

Monthly premium $38.90 $46.20

Yearly deductible $0 $150, for Tier 3, 4 and 5 drugs only

Tier 1, preferred generic, 30 days $0 $2

Tier 2, generic, 30 days $9 $9

Tier 3, preferred brand, 30 days $47 $47 after the deductible

Insulin, 30 days $35 $35, no deductible

Most you pay out of pocket in the year $2,100 $2,250

Changes to drugs you filled this year
Apixaban (Eliquis) stays on Tier 3. The new deductible applies to it.
Donepezil moves from Tier 1 to Tier 2.
Insulin glargine (Lantus) stays at $35.
Your other drugs stay on the tiers they are on now.

Pharmacies
Sorrelwood Pharmacy remains a preferred pharmacy in 2027. Mail-order supplies of 90 days
cost two and a half times the 30-day amount.
If you get help paying for your drugs
If you qualify for Extra Help from Medicare during the year, your premium and what you pay
at the pharmacy will be lower than the amounts in this notice, and we will write to you with the
new amounts.

How your premium is paid
If your premium is taken from your Social Security payment, the new amount will be taken
starting with the January payment. If you pay us directly, your January bill will show the new
amount.

Questions: Member Services, (888) 555-0137, 8 a.m. to 8 p.m., seven days a week. You can
compare plans at any time on the Medicare plan finder or by calling Medicare.

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SilverPine 2027 changes Document · saved Oct 1, 2026

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Value	Now
card-lorraine-partd.identification_number	SPR40981775

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only_in_file The extra-furosemide rule, one sentence on page 5 of the ten-page January 2025 discharge packet (one extra 20 mg tablet for a gain of 3 lb in a day or 5 lb in a week, call cardiology the same day, not more than two days running); the POA clause that lets Walt sell her house only after a physician's written statement and 30 days' notice to Russ; the principal balance on the September 2026 mortgage statement ($171,717.32); the memory test score (19 of 30); next year's drug plan premium ($46.20); the long-term-care daily benefit ($150); the 401(k) balance ($318,406.12 on June 30, 2026); every number on the September labs, which exist only as a portal screenshot (eGFR 33, A1c 7.9); the wind and hail deductible on Walt's house ($3,180); the owner and the title number on the Buick's title, which is a scan with no text (WALTER E PRUITT, 14 177 406219, no lien); the FMLA entitlement (480 hours for 2026); the lease clause that makes renter's insurance a condition, with $15 a month charged until proof is given; what Gentle Ridge has billed this year ($17,284.00 through September); mortgage interest paid in 2025 ($6,912.51); Camille's immunization dates.

attachments.yaml

record: doc-partd-anoc
template: document
org:
  name: SilverPine Rx
  lines:
  - PO Box 61180
  - Nashville, TN 37206
  phone: '8885550137'
  web: silverpinerx.example
  color: '#2d6a5f'
title: Annual Notice of Changes for 2027
body: 'September 22, 2026


  LORRAINE M PRUITT<br>2217 LARKMOOR LANE NW<br>CLEVELAND TN 37312


  **Member ID:** {{card-lorraine-partd.identification_number}} &nbsp;&nbsp; **Plan:** SilverPine Rx Value
  (Medicare prescription drug plan)


  You are enrolled in SilverPine Rx Value. Next year the plan''s costs and coverage will change. You do
  not have to do anything to stay in the plan. If you want a different plan, you can change between **October
  15 and December 7, 2026**. A change takes effect on January 1, 2027.


  ## What changes on January 1, 2027


  | | 2026 | 2027 |

  |---|---|---|

  | Monthly premium | $38.90 | $46.20 |

  | Yearly deductible | $0 | $150, for Tier 3, 4 and 5 drugs only |

  | Tier 1, preferred generic, 30 days | $0 | $2 |

  | Tier 2, generic, 30 days | $9 | $9 |

  | Tier 3, preferred brand, 30 days | $47 | $47 after the deductible |

  | Insulin, 30 days | $35 | $35, no deductible |

  | Most you pay out of pocket in the year | $2,100 | $2,250 |


  ## Changes to drugs you filled this year


  - Apixaban (Eliquis) stays on Tier 3. The new deductible applies to it.

  - Donepezil moves from Tier 1 to Tier 2.

  - Insulin glargine (Lantus) stays at $35.

  - Your other drugs stay on the tiers they are on now.


  ## Pharmacies


  Sorrelwood Pharmacy remains a preferred pharmacy in 2027. Mail-order supplies of 90 days cost two and
  a half times the 30-day amount.


  ## If you get help paying for your drugs


  If you qualify for Extra Help from Medicare during the year, your premium and what you pay at the pharmacy
  will be lower than the amounts in this notice, and we will write to you with the new amounts.


  ## How your premium is paid


  If your premium is taken from your Social Security payment, the new amount will be taken starting with
  the January payment. If you pay us directly, your January bill will show the new amount.


  Questions: Member Services, (888) 555-0137, 8 a.m. to 8 p.m., seven days a week. You can compare plans
  at any time on the Medicare plan finder or by calling Medicare.

  '