Page 2 - Cover Letter and Medicare Evaluation for Andrea Masters

Your physicians’ network affiliations

As shown in the appendices (A1, A2, and A3), all your physicians accept Medicare-approved
rates and are also listed in the network directories of the two Advantage plans compared in the
evaluation. Occasionally the network directories are not up to date, and so before enrolling in
an Advantage plan, it’s important to verify with your physicians’ offices that they will accept the
plan you’re going to enroll in.

How Medigap policies work

Since your evaluation compares two Medigap plans, and it may be helpful to review the pros
and cons of this type of coverage. Perhaps the most desirable attribute of Medigap policies is
the flexibility they offer. There are no networks, and you do not need referrals to see
specialists. You will be covered when you see any provider who accepts Medicare (according to
a study by the Kaiser Family Foundation, more than 99% of doctors and public hospitals do).

When you have a Medigap policy and go to a doctor or other medical provider who accepts
Medicare, he or she will send the bill for your visit to Medicare. Then Medicare pays the doctor
what it owes – usually 80% -- and forwards the 20% balance to the Medigap insurance company
that issued your policy. After the Medigap insurer pays the doctor some or all the 20% balance,
the doctor will then bill you for any remaining amount that was not paid by either Medicare or
the Medigap insurance company.

One attractive feature of this type of insurance is that Medicare makes the coverage decisions,
not an insurance company. When Medicare pays for a medical service or treatment, the
Medigap insurer is also required to pay. That’s different than an Advantage plan, where the
insurance company can in some instances decide whether a service is medically necessary or
requires prior authorization.

Also, Medigap policies cover some services that Medicare does not cover. As an example,
Medigap Plans G and N in your evaluation include coverage for medical emergencies when
you’re traveling to other countries This coverage has a $250 deductible, after which the
Medigap policy will pay 80% of the cost, with a $50,000 lifetime limit. The benefit summaries
of the two Advantage plans in your evaluation indicate that they provide some coverage for
worldwide emergencies, but there are no added details

Medigap policies do not cover prescription drugs, and so (as mentioned) you will need to enroll
in a Part D stand-alone plan. Neither do Medicare and Medigap policies cover hearing aids or
routine dental and vision care – but they do cover treatments for diseases of the eye including
glaucoma, cataracts, and macular degeneration.

The downside of Medigap policies is that they are expensive, especially in the state of New
York. People who acquire a comprehensive Medigap plan like Plan G or Plan N may spend more

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