Page 6 - Cover Letter and Medicare Evaluation for Donald Pender

their Rx coverage, unlike Advantage plans that can subsidize their drug coverage with profits
from their medical coverage.

If you need a short-term prescription filled, you will sometimes get better pricing at one of a
plan’s preferred pharmacies, which are listed on page 4 of your evaluation. And when you
enroll in your Rx drug plan (either Advantage or stand-alone), ask if your mail-order prescription
can be transferred from your current employer plan to the plan you are enrolling in. Otherwise,
you’ll need to request a new prescription from your doctor.

Comments

As you know, you will save a substantial amount by enrolling in Advantage plan if you see only
network doctors (unless it’s an emergency). The risk is that if you later want to switch to a
Medigap policy, insurance companies will ask questions about your health status, and you
might either pay steep premiums or be denied coverage.

Because there are many good Advantage plans in Orange County, you can switch to another
plan during annual enrollment if you need to. One reason you might do so is to see a specialist
who is not in your current plan’s network, or perhaps because Dr. Chen no longer accepts the
Advantage plan that you’re enrolled in.

Advantage plans are ideally suited for people in good health who do not go to their doctors
often and do not see several specialists. As people age, of course, they are likely to need more
medical services from more specialists who may not be in any Advantage plan networks.

The two Advantage plans that were compared in your wife’s evaluation have Dr. Chen listed in
their networks. But I did not include them in your evaluation because your Rx drug costs are
much higher in those two plans than in either of the Advantage plans in your evaluation. The
cost for dutasteride in the SCAN Classic HMO Advantage Plan is $280, and in the Blue Shield
Inspire HMO Advantage Plan, it’s $350.

Donald, please let me know if you have any questions. On your initial visits to your new doctors
after January 1, show the office staff your enrollment cards for Medicare A&B and the plan
you’ve selected. And on your first visit to the pharmacy, show them the enrollment card for the
drug plan you’re enrolled in. That will help to avoid any billing confusion. Also, you’re entitled
to a free “Welcome to Medicare” physical (see page 11 of the evaluation), but you may have to
request it.

Sincerely,

David Armes, CFP®

Appendices

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