Page 5 - Cover Letter and Medicare Evaluation for Dorothy Schmitt

But for some out-of-network services, this plan requires that you pay 40% of the cost, so
there is a strong incentive to use only network providers. Like most other Advantage
plans, this plan offers dental, vision, and hearing benefits and some coverage for foreign
travel emergencies (as does the Humana plan). Both your medical providers are listed in
this plan’s network (Appendix A), but before enrolling in either plan you should verify
that. This plan’s benefit summary is in Appendix C2.

Risk Assessment

Your minimum costs in each coverage option are shown on page 3 of your evaluation.
Minimum costs are the costs you know you’re going to pay – your premiums plus the co-
payments for the Rx drug you take.

In the two Advantage plans in your evaluation there’s no premium or co-payment for your Rx
drug, and since there are also no medical premiums, your minimum costs are your Part B
premiums of $1,979 a year. That’s roughly $2,400 less than your minimum costs will be with
your current Medigap policy and stand-alone drug plan.

During the year, of course, that $2,400 difference will be reduced as you make co-payments to
your Advantage plan. In a very unlikely worst case, you could wind up paying more in either of
the Advantage plans because of their high out-of-pocket limits -- $3,650 in the Humana Gold
Plus HMO-POS plan and $5,900 in the AARP Medicare Advantage Choice PPO Plan 1.

One way to think about the difference between Advantage plans and Medigap policies is that
with a Medigap policy you are paying high premiums to reduce your out-of-pocket risk. Because
your current Plan F covers all of Medicare’s gaps, you have zero out-of-pocket risk for
Medicare-covered services. In contrast, you have several thousand dollars of out-of-pocket risk
in either of the Advantage plans.

Rx Drug Plan Coverage

I couldn’t find an AARP plan in Sussex County that has a $33 premium this year (as you had
indicated in your e-mail). There are three AARP-sponsored Part D stand-alone plans in Sussex
County in 2023, and a side-by-side comparison of each of these plans’ costs at different
pharmacies can be found in Appendix D2.

Regardless of which AARP stand-alone drug plan you’re currently enrolled in, you’ll save money
in 2023 by switching to the SilverScript SmartSaver Prescription Drug Plan (PDP). In this plan if
you continue to get your prescriptions filled at a Rite Aid pharmacy, your Rx drug costs will be
an estimated $285.72 for the year. But if you get your prescriptions filled at a CVS pharmacy,
you can save an additional $170, as shown in Appendix D1. That’s much less than you’ll pay in
any of the AARP stand-alone drug plans.

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