Page 3 - Cover Letter and Medicare Evaluation for Scot Paltrow

The downside of Medigap policies is their high premiums. During a long retirement, someone
who has a Medigap policy may spend $100,000 or more for Medigap premiums. That does not
include Part B premiums or costs for prescription drugs.

Unlike most Advantage plans, Medigap policies do not cover routine dental and vision care or
hearing aids (neither does Medicare). The two Medigap plans compared in your evaluation –
Plan G and Plan N -- include some benefits for medical emergencies while traveling outside the
United States. Here are summaries of the two plans:

1) Medigap Plan G. This is the most comprehensive Medigap plan available to people who
turned 65 in 2020 or later. It covers all of Medicare’s gaps except for the annual Part B
deductible, which is $203 this year. Once you’ve paid the Part B deductible, then, you
will not have any cost-sharing for Medicare-covered services.

In New York City, individuals can likely purchase a Plan G policy for $3,400 a year or less
(about $285 a month). Many people like Plan G because they will have few co-
payments. Consequently, their costs for Medicare-covered services are predictable – it’s
the sum of their Part B premiums, Medigap premiums, and the Part B deductible. But
their Rx drug costs will vary depending on the drugs they take and the drug plan they’re
enrolled in.

2) Medigap Plan N. While this plan is slightly less comprehensive than Plan G, it still
provides solid coverage. The only differences between this plan and Plan G are that you
will have co-payments of up to $20 for doctors’ office visits and $50 if you go to the
emergency room. You should be able to get Plan G for about $225 a month ($2,700
annually).

The Aetna Medicare Premier Advantage PPO Plan (your current plan)

In this plan’s network directory, I was unable to find any of your three doctors who accept
Medicare (you mentioned in your cover memo that the doctors and hospital you use are not in
your plan’s network).

If they are not in the network, you will have higher co-payments when you see them. And in
this plan, there are 30% co-insurance requirements for several out-of-network services. Also,
when you see out-of-network doctors, any tests or screenings they order will likely also be
considered out-of-network costs. This plan’s benefit summary for 2022 is in Appendix C2.

Rx Drug Plan Coverage

If you switch to a Medigap policy and stand-alone, your Rx drug costs will be roughly $1,100
more in 2022 than if you remain in your current Advantage plan. Typically, Advantage plans
have lower costs for drugs than do stand-alone drug plans. The reason is that Advantage plans

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