Page 2 - Cover Letter and Medicare Evaluation for Scot Paltrow

Providers who accept Medicare but not the approved rates may charge up to 15% more.
Medigap Plan G in your evaluation covers these excess charges, but Plan N does not. Before
getting Plan N, you might first want to check with the offices of Drs. Goldstein and Kline to see
if they charge Medicare-approved rates. If they don’t, Plan G might be a better choice.

Medigap policies

The first two options in your evaluation are Medigap policies – Plan G and Plan N. These plans’
premiums are listed in Appendices B1, B2, and B3. The premiums shown in Appendix B1 are
from the New York Dept. of Financial Services and were current as of November 1. The
premiums in Appendix B2 (for Plan G) and B3 (for Plan N) are from CSG Actuarial, a quoting
service used by insurance agents.

In the state of New York, insurance companies cannot screen out people who have serious pre-
existing conditions or charge higher premiums to older individuals. And people can switch to a
Medigap policy at any time (although if they are in an Advantage plan, they will usually have to
wait until annual open enrollment to change).

Since insurers cannot decline coverage or charge people more because of their age or health,
and because New York City has high medical costs, it has the highest Medigap premiums in the
nation. This expense is partly offset by proving people unlimited latitude – they can switch to a
Medigap policy for 2022 and then switch back to an Advantage plan for 2023. Someone whose
physician recommends a joint replacement in the coming year can switch to a Medigap policy
for a year and then switch back to an Advantage plan during the next open enrollment.
Appendix B4 summarizes these consumer protections.

It might help to review some features that all Medigap policies share. Perhaps their most
desirable attribute is the flexibility they offer. There are no networks, and you do not need
referrals to see specialists. You will be covered when you see any provider who accepts
Medicare (according to the Kaiser Family Foundation, more than 99% of doctors and public
hospitals do, even though that’s not the case in New York City). And since Medigap policies are
nationally standardized, you can go to any doctor in the U. S. who accepts Medicare and you’ll
be covered. That’s in contrast to an Advantage plan where except in emergencies you are not
covered outside the plan’s service area.

Another strong point of Medigap policies is that Medicare (and not an insurance company)
makes the decisions about whether a service or treatment will be covered. When Medicare
agrees to cover something, the Medigap insurer cannot decline coverage, up to policy limits.
And because Medicare is more lenient in approving certain treatments and procedures than are
insurance companies, people with serious pre-existing conditions will typically get a Medigap
policy if they can afford it.

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