Page 5 - Cover Letter and Medicare Evaluation for Donald Pender

The two plans in your comparison both have Dr. Chen listed in their networks (but you should
verify that prior to enrolling), large provider networks, and either zero or very low costs for the
one Rx drug you take.

1) Platinum Advantage HMO Plan. This four-star plan is sponsored by Alignment Health
Plan, based in Orange County. It is one of several highly rated Alignment-sponsored
Advantage plans, as shown in Appendix C1. It has a low $698 out-of-pocket maximum
for medical (but not Rx drug) costs. Even if you reached that limit in a given year, you
would save more than $1,500 compared to what you would pay for a Medigap policy
and stand-alone drug plan.

This plan has no co-payments for office visits to your primary care doctor or to
specialists, and there’s no cost if you are hospitalized (these benefits are identical to
those of the Blue Shield 65 Plus HMO Plan below). There are no premiums and no
deductibles for either health or Rx drug coverage, and this plan appears to have
somewhat better dental coverage than the Blue Shield plan below. There are also some
vision and hearing benefits, as well as a dental supplement for $29 month. Before
enrolling, though, you should check with your dentist and optometrist to make sure
they will accept this coverage. This plan’s benefit summary is in Appendix C2.

2) Blue Shield 65 Plus Advantage HMO Plan. This plan also has an above-average
Medicare quality rating of four stars, and it shares several other features with the
Platinum plan – no co-pays for doctor’s office visits (either primary care or specialist) or
hospitalization, and zero premiums and deductibles for health and Rx drug coverage.

This plan’s catastrophic coverage limit of $999 is $301 higher than that of the Platinum
plan, and so there’s some additional risk. Dental and hearing coverage may be slightly
more limited here, based on descriptions in the benefits summary. But it is difficult to
know for certain because both plans have some discretion to decide what’s necessary
and will be covered. Vision coverage appears to be similar in both plans. This plan also
offers two dental supplements – one for a $12.40 monthly premium and the other for a
$41.90 monthly premium. Its benefit summary is in Appendix C3.

Rx Drug Plan Coverage

If you enroll in either of the Advantage plans, your annual costs for dutasteride for mail-order
refills will either be zero (in the Platinum Advantage HMO Plan) or $30 (in the Blue Shield 65
Plus Advantage HMO Plan).

But your Rx drug costs will be much higher if you get a Medigap policy and enroll in a stand-
alone drug plan. The lowest-cost plan for dutasteride is the Humana Walmart Value Rx
Prescription Drug Plan (PDP), where your estimated annual costs, including premiums, is
$398.96. The reason costs are higher in stand-alone plans is that they need to make a profit on

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