Page 3 - Cover Letter and Evaluation for Mr. Fred Falten

representative to support your position. Appeals of decisions that were based on incorrect
advice from Social Security are common, and there is an established appeals process. An appeal
should include the date and time that the incorrect information was given as well as the name
of the Social Security rep who provided that info. Again, it is unlikely that you would need to
appeal, but if there was a need you could do so.

It’s also remotely possible that if you and your wife drop Part B, when you later re-enroll you
might be able to get a Medigap policy without answering health-related questions. Even though
the rule is that you get only one Medigap open enrollment period, the insurance company that
sells you the policy might not ask whether you’ve had Part B before or check to see if you have.

Understanding Medigap Policies

Possibly the best feature of Medigap policies is that they cover you when you go to virtually any
doctor or medical provider in the United States. There are no networks, and you don’t need
referrals to see specialists. Another plus is that Medicare, and not an insurance company,
makes the coverage decisions. And if Medicare approves a service or treatment, the Medigap
insurer must also cover it, up to policy limits.

Since Medicare is more lenient in approving certain tests and treatments than are insurance
companies, Medigap policyholders may in some cases be covered for services that people in
Advantage plans may not be (the Advantage plan could say that a treatment is not medically
necessary). For that reason, people with pre-existing conditions who don’t have employer
retiree plans will typically get Medigap policies if they can afford them, as is also true for those
who are less concerned about cost.

Unlike most Advantage plans, Medigap policies do not cover routine vision and dental care or
hearing aids (none of which are covered by Medicare). It is possible, though, that there are
what are known as “innovative benefit” Medigap plans in New Hampshire that include limited
dental/vision benefits. Also, Medicare and Medigap policies do cover treatments for diseases of
the eye – cataracts, glaucoma, etc. – just not for routine eye exams and glasses.

The two Medigap plans compared in your evaluation – Plan F and Plan N – are both
comprehensive. With Plan F, you will not have any co-payments for Medicare-covered services.
And with Plan N, after you’ve paid the $203 Part B deductible, you will only have small co-
payments for doctor’s office visits and for emergency room visits. Plan F and Plan N also include
some coverage for foreign travel emergencies, which Medicare does not cover. And all Medigap
plans cover an extra 365 hospital days. The benefit designs of the 10 Medigap plans are on
pages 6-7 of the evaluation.

Medigap premiums

Estimated Medigap premiums from the New Hampshire Dept. of Insurance are in Appendix B.
As you review these premiums, one thing to be aware of is that the UnitedHealthcare policies

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