Page 1 - Cover Letter and Medicare Evaluation for Eric Hartman

November 18, 2022

Mr. Eric S. Hartman
4196 Racquet Club Drive
Huntington Beach, CA 92649

Dear Eric,

Your Medicare evaluation for the 2023 plan year is enclosed. As you know, if you decide to
change your coverage, you will need to do it by December 7.

The evaluation compares your current Advantage plan, which is an HMO, to an Advantage PPO
plan and two Medigap plans (Plan G and Plan N). As we’ve discussed, if you decide to switch to
a Medigap policy, you will need to answer questions about your health. Each insurer has its
own medical underwriting guidelines and has access to a database that shows which Rx drugs
you are taking. The Medigap premiums in the appendices are not underwritten quotes, and so
they are best-case quotes.

Medigap policies are expensive, but many retirees are willing to pay the higher cost to avoid
the restrictions that Advantage plans have – restrictions as to doctors you can see and medical
services that will be covered. Here’s an overview of how these two types of coverage work:

How Medigap policies work
When people first enroll in Part B, they have a six-month guaranteed issue period to purchase a
Medigap policy without answering questions about their health or pre-existing conditions. After
that initial six-month period is over, in California and most other states they will likely be
required to to answer health-related questions before they can get a Medigap policy. If they
have health problems, they will either pay much higher premiums or could be denied coverage.

Probably the most desirable quality of Medigap policies is the flexibility they provide. There are
no networks, and you do not need referrals to see specialists. Thus you are covered when you
see any provider who accepts Medicare (as a Kaiser Family Foundation study found that more
than 99% of doctors and public hospitals do). If at some future point you want to go to Johns
Hopkins Medicine or the Mayo Clinic, you’ll be covered by a Medigap policy.

Another plus is that coverage decisions are made by Medicare, not by an insurance company.
When Medicare covers a service or treatment, the Medigap insurer cannot question Medicare’s
decision. In an Advantage plan, by comparison, the insurance company decides whether certain
treatments are medically necessary, and it has a financial incentive to limit coverage. As one
example, Medicare almost always covers second opinions, while Advantage plans rarely do.