Page 2 - Cover Letter and Evaluation for Maria Elena Yajarano

Your physicians (but not your dentist) accept Medicare

Most of your physicians accept Medicare, but your dentist (Dr. Irvin) and your endodontist (Dr.
Farshey) do not. Since Medicare does not cover dental care, dentists are rarely listed in the
Medicare provider directory.

Also, the provider directory indicates that Dr. Putnam may accept Medicare-approved rates.
There are a few providers who accept Medicare but not Medicare-approved rates. In those
cases, they can charge up to 15% more than the approved rates. Those 15% excess charges will
be covered by Plan F and Plan G in your evaluation, but not by Plan L. So before getting Plan L,
you might check with Dr. Putnam’s office to see if he accepts Medicare-approved rates.

Mary Carlough is not listed as a Medicare provider, but you might want to verify that with her
office. Medicare covers some but not all counseling services.

No Advantage plans that will meet your needs

As noted, there aren’t any Advantage plans that will meet your needs. Four of the plans are
sponsored by Kaiser Permanente, which would require you to use Kaiser physicians. Two of the
plans are high-deductible Medicare Savings Accounts plans, and the only Advantage PPO plan
has a $300+ monthly premium.

Guaranteed issue protection for Medigap policy

Because you are involuntarily losing your employer-sponsored supplemental coverage, you
have a guaranteed right to get a Medigap policy without disclosing pre-existing conditions or
answering health related questions (your premiums will be adjusted for your age, though).

This is an important right, and in Maryland it is one of the few times when people who have
been enrolled in Part B for more than six months can be assured of getting a Medigap policy at
an affordable premium. Attached to this letter is Medicare’s explanation of this guaranteed
issue right. It is limited to people who currently have original Medicare, which means that
Medicare pays first and then the supplemental policy pays the balance (up to policy limits) –
which is the way your current supplemental indemnity policy works.

When you acquire a Medigap policy, the insurance company will ask for documentation that
you are involuntarily losing your supplemental coverage.

Understanding how Medigap policies work

Medigap policies are similar in many ways to your current indemnity supplemental plan,
particularly in the flexibility you have in choosing providers. There are no networks, and you will
be covered for those services that Medicare covers when you see any provider who accepts

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