Page 4 - Cover Letter and Evaluation for Raquelle Myers

If you choose the supplier, it is important to ask whether the company accepts Medicare and
Medicare-approved rates (also known as Medicare assignment).

With Medigap Plan G, your co-payments for DME will be fully covered after you have paid this
year’s $198 Part B deductible. The same is true for DME supplies covered by Part B, which are
100% covered after you’ve satisfied the Part B deductible. Attached to this letter is Medicare’s
explanation of how DME works and what it covers.

Rx Drug Plan Coverage

As noted above, people who get Medigap policies will also need to enroll in Medicare
prescription drug plans, i.e., stand-alone drug plans. The only way to find the lowest-cost plans
for a given set of drugs is to use Medicare’s Plan Finder, an online program in which you enter
the names, dosages, and monthly quantities of the Rx drugs you take. After these data are
entered, Plan Finder then identifies the stand-alone drug plans that have the lowest costs for
the drugs that you’ve entered.

When it ranks the plans by their costs, Plan Finder includes premiums, deductibles, and co-
payments. The results should be fairly accurate estimates of what you will pay. One reason the
costs are not exact is that drug manufacturers may increase prices later in the year, and if your
co-payment is 20% of the price, it will also increase. Also, most people do not fill all their drug
prescriptions on the first day of coverage, even though Plan Finder assumes that they will. And
because you take some drugs on an as-needed basis, the refill schedule may turn out to be
different than the ones entered into Medicare’s Plan Finder program.

Some of your drugs and supplies are covered by Part B. These include your test strips, lancets,
and Dexcom G6 blood monitor, sensor, and transistor. Part B also covers some external insulin
pumps, but the Omnipod system that you use is not one of them (it is covered by Part D). When
a drug or supply is covered by Part B and you get it at a pharmacy, you may need to show your
Medicare card and Medigap enrollment card to the pharmacist. When they are covered by Part
D, you may need to show the enrollment card for your stand-alone drug plan. And when you
get your prescriptions filled by mail-order, your Part B and Part D information will be stored in
your account profile.

You use 18 drugs that appear to be covered by Part D. Three of these -- the Omnipod products,
Novofine, and the BD insulin syringes (or any syringes) – are not listed in any of the Part D plan
formularies in Pierce County, at least according to Medicare’s Plan Finder. That leaves 15 drugs
that are listed in formularies in Pierce County, as shown in Appendix D1. These 15 drugs were
entered into Plan Finder.

According to Plan Finder’s cost rankings in Appendix D2, the two lowest-cost plans for your
drugs are both sponsored by Cigna-HealthSpring, and their costs are similar. The Cigna-
HealthSpring Rx Secure Essential Prescription Drug Plan has slightly lower costs, and based on
the drugs shown in Appendix D1, your total costs in this plan for the last five months of this

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