Page 4 - Cover Letter and Medicare Evaluation for Andrea Masters

service for insurance agents. Because the medical benefits for a given Medigap plan are
identical regardless of the company, you should choose a company that has low premiums. You
live in an area where Medigap premiums are lower than in most other parts of the state. That
indicates that medical services are less expensive in your area, and perhaps that people there
go to their doctors less frequently than they do in metropolitan areas.

In some cases, the quotes from the same insurance company are different in the DFS listings
and the CSG Actuarial listings. One reason could be that a few of the quotes from CSG Actuarial
may not include commissions (I don’t know which ones, though), and it’s also possible that
some quotes are out of date. Another unknown is that some companies may schedule their
annual increases during the first quarter, so that by the time your policy goes into effect on
April 1, premiums will be higher than those shown.

To get accurate current quotes, you will need to call two or three companies (their phone
numbers are in Appendix B2). Then you can choose the company that has the lowest premiums.
If premiums are similar for two companies, you might choose the company with the higher S&P
rating, as shown in the CSG Actuarial quotes. Several years ago, a government study found that
larger companies tend to have slightly smaller annual increases, on average.

The two Medicare Advantage plans in your evaluation

Saratoga County has 54 Advantage plans, and 11 of those plans have earned Medicare’s five-
star quality rating. But not all of them include Part D coverage (and are thus unavailable to you).
All the five-star plans in your area are sponsored either by CDPHP or Highmark.

Medicare’s quality ratings are thought to be good indicators of a plan’s overall merit. Among
other things, they measure whether the plans consistently provide recommended preventive
tests and screenings. And they also track customer satisfaction. When Advantage plans get high
ratings, the plans receive hefty bonuses from Medicare. Thus, the plan sponsors work hard to
get them. Even so, there are relatively few five-star plans nationwide – this year fewer than
10% of contracts have five-star ratings (one contract may include several plans).

Most Advantage plans include benefits for certain services not covered by Medicare, including
routine dental and vision care, and hearing exams. These two plans also have some coverage
for medical emergencies while traveling outside the United States.

The Advantage plans in your evaluation are five-star plans that have no premiums for health or
Rx drug coverage. One is an HMO, the other a PPO. All your physicians are listed in their
networks (see Appendices A2 and A3), although you should verify that before you enroll.

It’s also good to review these plans’ benefit summaries in the appendices as well as the side-by-
side comparisons on pages 2-4 of the evaluation. Here’s are brief descriptions of each plan:

4