Page 2 - Cover Letter and Medicare Evaluation for Diane Falten

1) Martin’s Point Generation Advantage Prime (HMO-POS) Plan. This has the lowest
overall costs of the three plans in your evaluation. As you may know, an HMO-POS plan
is an HMO that includes what’s known as a point-of-service option extends coverage in
limited situations when you see a provider who’s not in the network. Advantage plans
have the flexibility to define how this POS option works – in some plans, for instance, it
applies only to dental benefits, enabling you to be covered when you see a dentist who
is not in the plan’s network. In this plan, there is POS coverage for doctor’s office visits,
dental, hearing, and vision services, and for various outpatient services. I can send you a
list of these services if you wish.

All your providers except Rachel Orr are listed in the Martin’s Point Generations
Advantage network (although you should verify that before enrolling). I contacted
Martin’s Point Generations Advantage and asked if Dr. Orr is in their networks. I was
told that she is affiliated with Southern Maine Health Care (SMHC), which is in the
Martin’s Point Network. But you should verify this with her office before enrolling. If she
is not in this plan’s network, you may not be covered when you see her. This plan’s
benefit summary is in Appendix B2.

2) Humana Choice Advantage PPO Plan. Even though this is not a Martin’s Point plan, its
benefit design is strong, and its maximum out-of-pocket limit for medical services
($4,800 in network) is much lower than it is in either of the Martin’s Point plans in your
evaluation. One thing to keep in mind is that if you enroll in this plan and later decide
you want to switch to one of the Martin’s Point plans, you will not have to wait until
annual open enrollment. That’s because Medicare allows you to switch to a five-star
Advantage plan at any time of year (although you can switch only once a year).

Before enrolling in this plan, you’ll need to verify that all your providers are in the plan’s
network. If they are not in the network, you will still be covered when you see them, but
your costs will much higher. Dr. Morin is not listed individually, but the York Hospital
medical groups are listed, and according to the Medicare web site, he is in a York
Hospital specialty group. Also, Christina Stark is not listed, but the Appledore Medical
Group that she belongs to is listed. As always, though, verify this before enrolling.

This plan does not include dental coverage among its benefits, but it does sell two
supplemental dental plans. This plan’s benefit summary is in Appendix B3.

3) Martin’s Point Generation Advantage Flex Regional PPO Plan. This is a regional PPO
plan that provides quite a bit of flexibility and that may have a larger provider network
than the HMO-POS plan. But its prescription drug costs are the highest of the three
options. The provider network affiliations appear to be the same as those of the
Martin’s Point HMO-POS plan above, but before enrolling in this plan you should make
sure that your providers are still in the network. This plan’s benefit summary is in
Appendix B4.

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