Page 4 - Cover Letter and Medicare Evaluation for Dorothy Schmitt

qualifying (AARP’s underwriting guidelines are among the most lenient). And if you switch,
you’ll be in a plan where there is no current risk of being stranded. Phone numbers for the
insurers licensed to sell Medigap policies in Delaware are on the first two pages of Appendix B1.

The pricing of Medigap policies

As noted, CSG Actuarial’s premium comparisons in Appendix B1 and Appendix B2 show
premium quotes for Plan F and Plan N. Also, if you’d like to see quotes for Plan G, let me know.
CSG Actuarial is a quoting service for insurance agents, and in some cases the premiums shown
in the appendices may not include an agent’s commission (I don’t know which ones they are).
But for most companies, the premiums should accurately reflect what you will pay.

The CSG Actuarial comparisons indicate that when both spouses have a Medigap policy from
UnitedHealthcare/AARP, they each qualify for a 5% household discount. If you don’t know
whether you and Michael are both receiving this discount, you might verify that you are.

Comparing two Medicare Advantage plans

Most Advantage plans, including the two described below, include Part D coverage, which you
are required to have to avoid future penalties.

1) Humana Gold Plus HMO-POS Plan. This is an HMO plan with a point-of-service (POS)
option. In certain situations, HMO-POS plans enable you to be covered when you go to
an out-of-network provider, although you will usually have a higher co-payment. HMO-
POS plans have some latitude in how they design their out-of-network coverage rules,
but in most cases your primary care provider will need to refer you for out-of-network
care. The Beebe Medical Group is in this plan’s network (Appendix A).

This plan has an excellent Medicare quality rating of 4.5 out of 5 stars, a strong indicator
of a well-run plan that provides quality medical care and earns high customer
satisfaction scores. This plan has zero premiums for health and Rx drug coverage, no
medical deductible, and no co-payments for in-network primary care visits. In addition,
it offers some dental and vision benefits, and it has no co-payments for levothyroxine.
This plan’s benefit summary is in Appendix C1.

2) AARP Medicare Advantage Choice Plan 1 (PPO). This PPO plan’s quality rating is an
above-average 4 out of 5 stars, and its benefit design is similar to the Humana plan’s
above – no premiums for health and Rx drug coverage, no medical deductible, no co-
pays for primary care doctors’ office visits, and no co-pays for levothyroxine. Most
Advantage PPO plans have high out-of-pocket (OOP) limits, and while this plan’s OOP
limits are higher than the Humana plan’s, they are reasonable for a PPO -- $5,900 for
network costs and $8,950 for in- and out-of-network costs combined.

4