Page 3 - Cover Letter and Evaluation for Susan Church

2) The Humana Choice PPO Plan (H5216-147). This large PPO plan has more than 20,000
providers and an above-average Medicare quality rating of 4 stars. Its out-of-pocket
limit is high -- $6,700 in network and $10,000 in and out of network – although this
amount is relatively common for a PPO plan.

In this plan if you see a non-network provider, you will pay 25% of the cost. Also, as
shown in Appendix B4, there are often steep costs for going outside the network, even
though you will have some coverage. Like the Humana Gold Plus HMO Plan, this plan
has some benefits for dental and vision coverage.) Benefit details are in Appendix B4.

3) The Humana Choice PPO Plan (H5216-153). This plan has the same network as the
previous plan but is riskier due to its $1,000 deductible for medical costs. In the
minimum cost calculations on page 3 of the evaluation, I’ve assumed that you would
spend this $1,000 (even though you might not).

An unusual feature of this plan is that it provides a $50 a month rebate (or refund) of
your Part B premium. So, if you were enrolled in this plan for the entire year, you would
receive $600 in Part B rebates. The plan’s $1,000 medical deductible, then, is partly
offset by the rebates.

This plan is designed for people in very good health who do not expect to go to their
doctors very often – they don’t expect to spend the deductible and they’ll get a $50 a
month refund on their Part B premiums. This plan does not include dental and routine
vision benefits, although they can be purchased for an extra premium. And its co-
payments for doctors’ office visits and other services are much higher. This plan’s
benefit details are shown in Appendix B5.

The Medigap policy in your evaluation

Even though you plan to enroll in an Advantage plan, it might be helpful to compare a Medigap
policy. During the first six months that you are enrolled in Part B, you can get a Medigap policy
without answering questions about your health or disclosing pre-existing conditions. After this
six-month period has past, in most states you will be medically underwritten before you can get
a policy or upgrade to a more comprehensive Medigap plan.

There are, though, a few special enrollment periods that will sometimes give you a guaranteed
right to get a Medigap policy – one example involves those in Advantage plans who move away
from their plan’s service territory,

Probably the best feature of Medigap policies is that there are no network restrictions. People
who have these policies can go to any doctor who accepts Medicare, as 99% of them do.
Medigap policies do not cover routine vision and dental care or hearing aids. Some Medigap
plans, including the one compared in in your evaluation, have some coverage for foreign travel
emergencies.

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