Page 4 - Cover Letter and Evaluation for Bob Workman

This plan has several good features that include zero premiums for health coverage and a zero
health plan deductible. It also has a sizable network of more than 20,000 providers, and an
above-average 4-star quality rating from Medicare.

It’s not clear whether Dr. Miranda is in this plan’s network. She belongs to the Providence
Medical Group, which is listed in this plan’s network (see Appendix A), but it’s possible that not
all Providence providers are in the Humana network. Before enrolling in this plan, you should
verify that she is in this plan’s network. If she is not, you will still be covered when you see her
but will pay 50% of the cost. It’s may not be a good idea to choose this plan if she is not in its
network.

Rx Drug Coverage

With any of the four medical coverage options in your evaluation, you will also need to be
enrolled in a Part D stand-alone plan (as you currently are). In 2018, the lowest-cost stand-
alone plan for the drugs you take is the Envision Rx Plus Prescription Drug Plan. According to
the Medicare web site’s cost information in Appendix D2, you will pay $321 for your drugs in
this plan in 2018 if you get mail-order refills. That cost includes premiums, deductible, and co-
payments. Your actual cost could be lower, depending on how often you use the Ventolin
inhaler. I assumed that the 8-gram inhaler will last you for two months, on average.

Although Walgreens is the local pharmacy that you typically use, you can save money if you go
to one of the Envision Rx Plus plan’s preferred pharmacies when you need short-term
medications. Walgreens is not a preferred pharmacy in this plan, but CVS and others are, as
shown in Appendix D2.

Analysis

You can substantially reduce your premiums (or fixed costs) if you are willing to accept more
risk. Two of the options in the evaluation -- Plan K and the Humana Choice PPO Advantage plan
-- both have much lower premiums but more out-of-pocket risk that you currently have with
your Plan N coverage.

In Plan K, your annual premiums would probably be about $800 less than they are now. But in
this plan you will have additional co-payments, possibly substantial ones. Still, you would likely
save money in this plan so long as you didn’t have expensive tests and treatments.

In the Humana Choice PPO Plan, your combined premiums and deductible are approximately
$1,800 less than they are in Medigap Plan N. But in this Advantge plan you will numerous co-
payments, although most of them will be small ones if you see network doctors. Again, you
might save a substantial sum in this Humana plan, but it carries more risk (even though this
plan’s out-of-pocket limits are lower than those of most other Advantage PPO plans).

4