Page 5 - Cover letter and evaluation for Marcelle Nesci

be accepting more out-of-pocket risk, particularly when you go out of network, where for some
services you will pay 40% of the cost. This plan’s out-of-pocket limit for network services is
$6,700, a number that rises to $10,000 when you include non-network services. Those are
standard out-of-pocket limits for Advantage regional PPO plans. Medicare’s summary of this
plan’s costs and benefits are in Appendix C2.

Rx Drug Plan Coverage

Medigap policyholders are required to have Part D stand-alone plans. The lowest-cost stand-
alone plan for your Rx drugs is the Express Scripts Medicare-Saver Prescription Drug Plan. Its
estimated annual costs for the full year are $761 if you get mail-order refills. That amount
includes premiums, deductible, and co-pays. The downside is that this plan has a below-average
2.5-star quality rating from Medicare, which indicates past problems.

You may be better off, then, in choosing the next lowest-cost stand-alone drug plan -- the
SilverScript Choice Prescription Drug Plan. Its estimated full-year costs for your drugs is $765
(only $4 more than the Express Scripts plan) if you get mail-order refills. The SilverScript Choice
plan has a 3.5-star quality rating.CVS is listed as a preferred pharmacy in both these plans.

If you enroll in an Advantage plan, your Rx drug coverage is included, and it cannot be
unbundled from the plan. In the UnitedHealthcare Medicare Complete Choice Plan 1 in your
evaluation, the estimated annual costs for mail-order refills are $624. Those costs jump to $967
if you get refills at a local pharmacy. This plan does not have preferred pharmacies.

Summary

If you try an Advantage plan, in New York you have the assurance that you can switch to a
Medigap policy and Part D stand-alone plan later without having to answer health questions. To
do that, you would need to switch during Medicare’s open enrollment period (October 15 –
December 7), with your new coverage going into effect on January 1. Or you could start with a
less comprehensive Medigap plan like high-deductible Plan F and then upgrade later.

Finally, there are a couple of things to keep in mind as you make the transition to Medicare. On
your initial visits to your doctors after March 1, show the office staff your new enrollment
cards. 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’ll probably have to request it.

Sincerely,

David Armes, CFP®

Attachment: Your physicians’ network affiliations
WDA:12115

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