Page 4 - Cover Letter and Medicare Evaluation for Eric Hartman

benefits are zero co-pays for doctors office visits (primary care and specialist) so long as
they are in network.

And as you mentioned, there is a Part B premium reimbursement. In 2023, the
reimbursement will be $110 a month ($1,320 a year), and that amount will be applied to
the Part B premiums that Social Security deducts from your monthly payments. On page
3 of the evaluation I’ve estimated that after subtracting the reimbursement, your Part B
premiums will be only $54.90 a month ($658.80 a year). That’s for the standard Part B
premium, and individuals with higher incomes may have higher Part B premiums.

There’s also a SCAN Venture HMO Plan in Riverside County, but I don’t know whether
you’d be covered when you’re in the desert unless it’s an emergency (or at least
urgent). Advantage HMO plans are usually specific to a county, and in a neighboring
county they often have different networks and different benefit designs. But it wouldn’t
hurt to ask SCAN about non-urgent coverage when you’re in the desert. This plan’s
benefit summary is in Appendix C1.

2) Alignment Health PPO powered by HOAG. This plan’s quality rating of 3.5 stars is lower
than the SCAN Venture’s plan, and its $3,900 out-of-pocket limit for network services is
almost four times higher than the SCAN Venture Plan’s OOP limit. For some out-of-
network services, this plan requires that you pay 30% of the cost, and so there is a
strong incentive to use only network providers. Finally, this plan does not have any
dental coverage unless you choose to buy a supplemental benefit package for $63 a
month. The benefit summary is in Appendix C2.

Risk Assessment

Your minimum costs in each coverage option are shown on page 3 of your evaluation.
Minimum costs are the costs you know you’re going to pay – your healthcare premiums,
premiums and co-payments for the Rx drugs you take, and the medical deductibles (these costs
assume you will pay the medical deductible but not the drug deductible). These are the
estimated minimum costs for each option in 2023:

Medigap Plan G + SilverScript SmartRx drug plan $5,139
Medigap Plan N + SilverScript SmartRX drug plan $4,739
SCAN Venture Advantage HMO Plan $659
Alignment Health Advantage PPO Plan $1,979

As you can see, there’s a $4,480 difference in minimum costs between Plan G and your current
SCAN Venture plan. And a $4,080 difference between Plan N and the SCAN Venture plan.
During the year, of course, those differences will change as you make co-payments.

The only reasons you might switch to a Medigap policy + stand-alone drug plan are to give you
a virtually unlimited choice of providers and nationwide coverage. You would not need referrals

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