Page 2 - Cover Letter and Evaluation for Michael Boucher

With a Medigap policy, then, you can go to virtually any doctor, public hospital or clinic in the
United States and you’ll be covered.

You mentioned that you travel to other countries on occasion, and Plan G has some coverage
for foreign travel medical emergencies (see pages 6-7 of the attached evaluation). This foreign
travel benefit includes a $250 deductible per emergency, after which the Medigap plan covers
80% of the balance, with a $50,000 lifetime limit.

Another strength of Medigap policies is that Medicare, not the insurance company, makes the
coverage decisions. And if Medicare approves a service or treatment, the Medigap insurer must
also cover it, up to policy limits. Because Medicare is more lenient in approving certain
treatments than are insurance companies, Medigap policyholders may in some cases be
covered for treatments that people in Advantage plans may not be (the Advantage plan could
say that the treatment is not medically necessary).

What’s Not Covered by Medicare and Medigap Policies

Neither Medicare nor Medigap policies cover routine vision care and eyeglasses. But Medicare
does cover diseases of the eye – glaucoma, cataracts, etc. Nor does Medicare cover dental care
or hearing aids. And with some exceptions, most chiropractic care is not covered. In addition,
most medical services that are covered by Medicare have limits to their coverage, although the
limits are typically generous.

Medigap Open Enrollment Rule

During the first six months that people have Part B, insurance companies are required to sell
them Medigap policies without asking health-related questions. But in Texas and most other
states, once this six-month period is over, insurers will ask applicants about pre-existing
conditions and can charge them higher premiums or deny coverage.

Your Rx Drug Plan Coverage

You indicated that you have enrolled in the SilverScript Smart Rx plan, effective May 1. It is the
lowest-cost plan for the two drugs you take (at least it is for the last eight months of this year).
This plan has a $7.30 monthly premium and a $445 annual deductible, which is the standard
deductible for Medicare prescription drug plans.

As you know, you will pay the full price for your Rx drugs until the $445 deductible is satisfied.
After that, if you continue to get monthly refills of your drugs at CVS, your costs will level off at
about $73 a month, including the plan’s premium. SilverScript is a national plan owned by CVS,
and so you can get refills at any CVS pharmacy in the country (as well as at many other
pharmacies).

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