Page 4 - Cover Letter and Medicare evaluation for Dr. Peter Yesawich

1) Medigap Plan F. This is the most comprehensive Medigap plan. It covers all of
Medicare’s gaps, which makes your costs predictable. You won’t have any co-payments
for Medicare-covered medical services during the year. You should be able to get Plan F
for about $3,300 a year ($275 a month). Another option is to get Medigap Plan G, which
is identical to Plan F except that it does not cover the Part B deductible, which will be
$203 in 2021. Plan G’s annual premiums are $200-$225 less than Plan F’s.

2) Medigap Plan N. This plan is slightly less comprehensive than Plan F, but it still provides
solid coverage. Its gaps include the $203 Part B deductible, co-pays of up to $20 for
doctor’s office visits, and a $50 co-pay for emergency room visits. Annual premiums are
roughly 20-25% lower than Plan F’s, and you would probably save money in this plan
unless you go to your doctors often. If you initially choose this plan and later want to
upgrade to Plan F or Plan G, you will probably have to answer questions about your
health status and disclose any pre-existing conditions. Annual premiums for Plan N are
about $2,500 or less.

The two Medicare Advantage plans compared in your evaluation

Because you see physicians in other states, I selected two Advantage PPO plans for your
evaluation. As you know, in a PPO plan you will have some coverage when you go to out-of-
network providers – unlike an HMO plan in which there’s no out of network coverage except in
emergencies.

Advantage plans generally have low fixed costs – low premiums, Rx drug costs, and plan
deductibles – along with high out-of-pocket risk. The two Advantage plans in your evaluation
are examples of this pattern – they have zero premiums for health and Rx drug coverage and
zero deductibles for their health coverage. But their out-of-pocket maximums are high --
$10,000 when you include costs for seeing out-of-network providers.

As a rule, then, Advantage plans are well suited for retirees in good health who do not want to
pay high Medigap premiums. Enrollees are willing to accept greater out-of-pocket risk as well as
the longer-term risk that if they later want to switch to a Medigap policy, they may be unable to
do so.

A list of the Advantage plans with the lowest costs for your Rx drugs is in Appendix D1. This list
is sorted by the plans’ estimated annual costs for your drugs in 2021. I selected the two lowest-
cost PPO plans for your evaluation. Dr. Piloto is listed in both plans’ networks (Appendix A2),
but before enrolling in either of these plans, you should verify that with his office.

There are Advantage plans in the Chicago area that are sponsored by Bright and Aetna, but
even if your doctors there are in those plans’ networks, it’s unlikely they would be considered a
network provider if you were enrolled in a Florida plan.

Here’s are brief summaries of these two Advantage PPO plans:

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