Page 4 - Cover Letter and Evaluation for Steve Decker

available when both spouses buy their policies from the same company. While not all
companies offer these “household discounts,” the ones that do may have substantially reduced
premiums. And some insurers provide extra non-medical benefits like health club memberships
and in a few cases, limited dental/vision coverage.

The two Medicare Advantage plans in your evaluation

Medicare Advantage plans are managed-care plans – mainly HMO’s and PPO’s. There are 27
Advantage plans in Litchfield County, and for the evaluation, I selected an Advantage Regional
PPO plan and an Advantage HMO plan. Both plans are sponsored by UnitedHealthcare and are
among the lower-priced plans for your prescription drugs. Your four physicians are listed in
these plans’ provider directories.

Occasionally the online provider directories are out of date, and so it’s important that prior to
enrolling in an Advantage plan, you verify with your physicians’ offices that they are still in
the plan’s network. In the HMO plan, as you know, you will pay full cost for any out-of-network
services (emergencies are exceptions). And in the PPO plan, you will have a higher co-payment
when you see a doctor or other medical provider who is not in the plan’s network.

In addition, both plans have supplemental dental packages you can get for an added premium.
But before purchasing this supplemental coverage, check with your dentist to make sure he
accepts this dental plan).

Following are brief descriptions of each plan, with detailed benefit summaries in the
appendices.

1) AARP Medicare Advantage Choice Regional PPO Plan. This plan has a $47 monthly
premium for health and Rx coverage. Of that amount, $22.80 a month is allocated to the
health premium and $24.20 a month to the Rx drug premium. On page 3 of your
evaluation, the health premium is shown as a separate cost while the Rx drug premium
is included in your overall Rx drug costs.

Regional PPO plans like this one usually have larger networks than local PPO plans. That
could be a benefit if you need to find a new specialist or other provider. But Medicare
no longer indicates the number of providers in each Advantage plan, and so it’s only a
guess that this is a large-network plan.

Advantage PPO plans typically have high out-of-pocket maximums for medical expenses,
and this one has a $5,500 OOP limit for medical services in network and a $10,000 OOP
limit for in and out-of-network services combined. Medicare gives this plan’s overall
quality a 3.5-star rating (out of a possible 5 stars), which is average. This plan’s benefit
summary, including its costs for your drugs, is in Appendix C2.

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