Page 2 - Cover letter and evaluation for Peter Smith

Medicare Advantage plans

Your evaluation compares four Advantage plans – three HMO’s and one PPO. The three HMO
plans have relatively low costs for the prescription drugs that you take. The PPO plan, on the
other hand, has much higher costs for your Rx drugs, and it’s included so that you can see the
tradeoffs involved in choosing a PPO, which can often be the best type of coverage for
someone. But this PPO plan in does not appear to be a particularly good fit for you, even
though it has some appealing features.

As you know, in an HMO plan you are required to use network doctors except in cases of
emergency. HMO’s are typically the most cost-effective type of Medicare supplemental
coverage. But the tradoff for HMO’s low costs is tightly restricted care where referrals are
required before you can see a specialist and where proposed treatments are often subject to
review and prior approval.

Here are the four Advantage plans compared in your evaluation.

1) The Anthem Value Plus HMO Plan. This plan has the lowest-costs for the prescription
drugs you take, as discussed in the Rx drug coverage section below. It also has no
premiums or deductibles for medical coverage and a very low $2,500 out-of-pocket limit
for medical (not including Rx drug) costs. Its overall quality rating from Medicare is 3.5
stars, which is considered average. This plan’s weakest point appears to be its small
provider network, with between 250 and 500 providers (a provider can be a physician, a
medical group, a hospital, clinic, or therapist).

2) The AARP Medicare Complete Plan 1 (an HMO). This plan has an above-average 4-star
quality rating from Medicare and a provider network that’s larger than that of the
Anthem Value Plus HMO plan. Like the Anthem plan, this plan has a low $2,500 out-of-
pocket limit, zero health care premiums and no health plan deductible. One downside of
this plan is that its costs for your prescription drugs are $500+ more than those of the
Anthem Value Plus HMO plan. Dr. Dunsmoor is listed in this plan’s network, in the event
you decide to continue seeing him.

3) The Senior Dimensions Southern Nevada Plan (an HMO). This plan is almost identical to
the AARP Medicare Complete Plan 1 above (both plans are sponsored by
UnitedHealthcare). The two main differences are 1) the Senior Dimensions Plan has a
larger network, perhaps by as many as 500 or more providers, which gives you a wider
choice if you need to find a new specialist, and 2) it has a 3.5-star quality rating from
Medicare, which is one-half staf lower than the 4-star rating of the AARP Medicare
Complete Plan 1. Quality ratings are assessed based almost 50 criteria, including clinical
care and customer satisfaction. And both plans have above-average coverage of services
that Medicare does not cover – routine dental and vision care and hearing aids
(although your dentist and optometrist may need to be in network).

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