Page 2 - Cover letter and evaluation for Carol Smith

policy. With Advantage plans, then, you have the flexibility to move to a PPO later if there’s a
better one around or if your needs have changed.

In an HMO plan you are required to use network doctors except in cases of emergency. HMO’s
are typically the most cost-effective type of Medicare supplemental coverage. But the tradoff
for HMO’s low costs is tightly restricted care where referrals are required before you can see a
specialist and where treatments are often subject to prior approval.

As you compare the four Advantage plans in your evaluation, you might verify that the doctors
you want to see are in a plan’s network. If you haven’t decided who your primary care doctor
will be before you enroll, you might give added weight to plans with larger provider networks
since that will give you a greater choice of doctors. To find out whether a doctor is in an
Advantage plan’s network, you can either call the plan or the doctor’s office.

1) The Humana Gold Plus HMO Plan (an HMO). There are several things going for this
plan. With more than 4,500 providers, it has the largest network of the plans compared
in your evaluation. And its $1,900 out-of-pocket limit is the lowest of the four plans (as
you may know, a plan’s out-of-pocket limit does not include premiums or prescription
drug costs -- both of which are zero in this plan).

In addition, the Humana Gold Plus HMO Plan has an above-average quality rating of four
stars, a $200 maximum cost for an inpatient stay at a hospital, no co-payments for
primary care office visits and $10 co-payments for specialist’s office visits.

2) The AARP Medicare Complete Plan 1 (an HMO). This plan also has an above-average
four-star quality rating from Medicare, a low $2,500 out-of-pocket limit, zero health
care premiums and no health plan deductible. Moreover, there is no cost for a
hospitalization, which is unusual for an Advantage plan.

3) The Senior Dimensions Southern Nevada Plan (an HMO). This plan is similar to the
AARP Medicare Complete Plan 1 above (both plans are sponsored by UnitedHealthcare).
The two main differences are 1) the Senior Dimensions Plan has a larger network,
perhaps by 500 or more providers, 2) it has a 3-5 star quality rating from Medicare,
which is one-half point lower than the ratings of the other three plans. Quality ratings
are assessed based a number of criteria, including clinical care and customer
satisfaction.

4) The Aetna Medicare Choice Plan (a PPO). As noted earlier, this plan does not seem to
be a good match for you. It does, though, have some strong features including a
network of more than 2,500 providers and an above-average 4-star quality rating from
Medicare. But it has a high $6,700 out-of-pocket limit for network services. There are
also stiff penalties for going to non-network doctors, where you will typically pay 40% of
the cost. And this plan has a $750 health plan deductible, which on page 3 the
evaluation assumes you will spend.

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