Page 2 - Cover letter and evaluation for Lee Palmiter

2) The second step is to enroll in a Part D stand-alone plan by calling the plan’s toll-
free number shown on page 4 of your evaluation. You do not need to have Part B to
enroll in a stand-alone drug plan – your Part A coverage is all that you need to
enroll. So, you might want to do this step first and get it out of the way. There are
two stand-alone drug plans that have the lowest costs for your prescriptions, and
they are discussed below.

All your physicians accept Medicare

As shown in Appendix A, the Summit Medical Group, which includes your three doctors,
accepts Medicare. I found Dr. Schachtman in the Medicare provider directory but not your
other two doctors. It is common, however, for doctors who belong to medical groups not to be
listed on the Medicare web site.

It is possible that Dr. Jawetz and/or Dr. Porras accept Medicare but do not accept Medicare-
approved rates (according to the Medicare web site, Dr. Schachtman accepts Medicare-
approved rates). When a doctor does not accept Medicare-approved rates, he or she can
charge up to 15% more.

Three of the Medigap plans in your evaluation cover this extra 15% charge, although for Plans G
and High-Deductible F you will first have to pay the plan’s deductible. Plan N does not cover this
excess charge, which is usually a few dollars but in rare cases can be more. You can check with
Summit or with either of these doctors to see if they accept Medicare-approved rates. It’s likely
that they do.

Medigap policies

It might help to explain how Medigap policies work, including their strengths and weaknesses.
As you are aware, Medigap policies are supplemental (or secondary) coverage. If you have a
Medigap policy and go to the doctor, he or she sends Medicare the bill. Then in most cases,
Medicare will pay 80% of the approved amount and forward the 20% balance to the Medigap
insurer, who will pay some or all the balance, depending on the plan that you have and whether
the deductible has been met.

From the patient’s perspective, this approach has several benefits. First, because Medicare
does not have networks, you can go to any provider who accepts Medicare, as 99% of doctors
and public hospitals do.

Second, Medicare makes the coverage decisions and not the insurance company. When
Medicare approves a procedure or treatment, the Medigap insurer cannot question the
decision. And Medicare is much more likely to approve some types of treatments than are
insurance companies.

2