Page 3 - Cover Letter and Evaluation for Janet Tuma

If you later want to switch to a different Advantage plan, you can do so each year during
Medicare’s open enrollment period (October 15 – December 7), and your new coverage will go
into effect on January 1. And unlike applying for a Medigap policy, you cannot be asked
questions about your health or pre-existing conditions.

Here are brief summaries of the three Advantage plans in your evaluation. Before choosing a
plan, you might want to review the plans’ benefit summaries in the appendices.

1) Aetna Medicare Value PPO Plan. This plan has an above-average Medicare quality
rating of four stars. Even though a PPO plan covers you when you see an out-of-network
provider, you will pay substantially more outside the plan’s network. As an example, in
this plan you might pay as much as 50% of cost for certain out-of-network services
(emergencies are exceptions).

This plan’s out-of-pocket limit is $3,950 for network services, but the limit jumps to
$8,250 for in- and out-of-network services combined. If someone enrolled in this plan is
hospitalized, he or she will have a $300 a day co-payment for days 1-7 in a network
hospital. That is a substantially greater hospital cost risk than in the other two plans.
This plan’s benefit summary is in Appendix C.

2) Cigna Preferred Medicare HMO Plan. This plan has several good features, although its
quality rating from Medicare is only three stars, which is lower than the other two plans
in the evaluation. As you know, in an HMO plan you will not have any coverage outside
the network unless it’s an emergency.

This plan’s out-of-pocket limit is $3,450, which is slightly better than average for an
Advantage HMO plan. If you are hospitalized, you will pay $195 a day for days 1-7. And
for more expensive medical services, you may be asked to pay 20% of the cost. For more
details, see the plan’s benefit summary in Appendix D.

3) Humana Gold Plus HMO Plan. This plan appears to have a slightly stronger benefit
package than the other two plans. It has an above-average Medicare quality rating of
four stars (the same as the Aetna Medicare Value PPO Plan). It also has the lowest out-
of-pocket limit for medical costs ($2,650) of the plans in your evaluation.

In addition, it has the lowest risk for hospital costs -- $150 a day for days 1-7. But like
the Cigna plan above, co-insurance payments for expensive medical services are often
20% of the cost. For more details, see the plan’s benefit summary in Appendix E.

Extra Benefits

Advantage plans offer additional benefits that are not available with traditional Medicare and
Medigap policies. Besides having some dental, vision, and hearing aid benefits, plans may offer

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