Page 6 - Cover Letter and Evaluation for Mr. Fred Falten

Moreover, those out-of-network costs would apply only to the plan’s $8,500 out-of-
pocket limit for in- and out-of-network services combined (the plan’s $6,700 out-of-
pocket limit applies only to services received in network). This plan’s benefit
summary can be found in Appendix C3.

Your Rx Drug Plan Coverage

The names, dosages, and monthly quantities of your Rx drugs are shown on the first page of
Appendix D1. Aspirin and Armour Thyroid are not included in this list – because aspirin is an
over-the-counter drug, it is not covered by Part D, and Armour Thyroid is not listed in any of the
plans’ drug formularies.

As mentioned, if you get a Medigap policy you will also need to enroll in a stand-alone drug
plan. Based on the list in Appendix D1, the lowest cost stand-alone plan for your Rx drugs is the
Anthem MediBlue Rx Enhanced Prescription Drug Plan. Its estimated costs for your drugs for
the last nine months of this year are $212 at a CVS pharmacy, including premiums and co-
payments. To enroll in this plan, call (855) 793-1938.

In the Martin’s Point Generations Advantage Prime Plan (HMO-POS), there is no cost for your
Rx drugs for the last nine months of this year. And in the Humana Choice PPO Plan, you will pay
an estimated $102 for your drugs over the last nine months. If you enroll in either of these
plans, your drug coverage is included in its overall benefit package.

One way you might be able to reduce your drug costs is to request a “formulary exception” for
Armour Thyroid from the plan you enroll in. When you enroll, let the plan know you want to
request a formulary exception. Your request would need to include a letter from your doctor
explaining why you need Armour Thyroid instead of another drug that is used to treat the same
condition and that is on the plan’s formulary. There’s no certainty that a plan will agree to the
exception.

Finally, when you do switch to Medicare as your primary coverage, there are a couple of things
to keep in mind in making the transition. On your initial visits to your doctors after you switch,
show the office staff your new enrollment cards. That will help to avoid any billing confusion.
And show your Part D enrollment card to your pharmacist. 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®

Appendices
WDA:3290004

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