Page 5 - Cover Letter and Medicare evaluation for Dr. Peter Yesawich

1) Bright Advantage Part B Savings PPO Plan. Among its benefits, this plan gives its
enrollees partial rebates for the cost of their Part B premiums. Enrollees continue to
pay their monthly Part B premium to Social Security and the plan gives them $80
monthly rebates. That’s why the Part B premiums for this plan, shown on page 3 of
the evaluation, are lower than Part B premiums for the other plans.

This is a new plan in Florida, and it does not yet have a quality rating from Medicare.
As is typical for a new plan, this one has much lower than usual costs as it seeks to
gain market share (there are 48 Medicare Advantage plans in Palm Beach County).
But those costs quickly rise when you leave the plan’s network, where in most cases
you will pay 40% of the cost. And if an out-of-network provider refers you for a lab
test or an MRI or a diagnostic X-Ray, you will also pay 40% of those costs. This plan’s
benefit summary is in Appendix D2.

2) Aetna Medicare Premier Plus PPO Plan. Medicare gives this plan an above-average
quality rating of four stars, an indicator of a fairly high level of customer satisfaction.
It has a lower out-of-pocket limit for network services than the Bright Advantage
plan ($4,900 compared to $5,400), but you will pay 50% of the cost when you go out
of network -- out-of-network costs count only toward the plan’s higher $10,000 OOP
limit for in and out-of-network services combined.

This plan has higher costs for your Rx drugs than does the Bright Advantage plan,
and its co-pays for doctors’ office visits to out-of-network physicians are a steep $65.
This plan’s benefit summary is in Appendix D3.

Rx Drug Plan Coverage

Please check the list of your Rx drugs, dosages, and monthly quantities that’s attached to this
letter to make sure they are correct. This is the list that the Medicare Plan Finder program used
to estimate your costs in each option.

There is a wide discrepancy between the costs for your drugs in the Advantage plans and in the
lowest-cost Part D stand-alone plan that goes with a Medigap policy. I checked to see if this
discrepancy exists in the Chicago area, and while the numbers there are slightly different,
there’s still a wide price gap for your Rx drugs between the lowest-cost stand-alone plan and
the lowest-cost Advantage plan.

One reason for this is that Advantage plans can keep their drug costs low by redirecting a
portion of the monthly payments they receive from Medicare for medical benefits. Knowing
that drug costs are an important selection criterion for many retirees, Advantage plans try keep
these costs as low as they can. Even though Advantage plans may only break even or possibly
lose money on their drug coverage, they can compensate for it with profits from their medical

5