Page 2 - Cover Letter and Evaluation for Diann Weade

dental care, and so there is no need for dentists and periodontists to sign a Medicare contract.
In your enhanced dental supplement plan from Guardian, it’s likely that both of them are
network providers.

You indicated that you would like to see comparisons of Medigap policies as well as Medicare
Advantage plans. Your evaluation compares two Medigap plans (Plan G and Plan N) and two
Medicare Advantage HMO plans, including the plan you are now enrolled in.

Medigap policies

It might help to explain how Medigap policies work, including their strengths and weaknesses,
and the ways in which they are different from Medicare Advantage plans. Medigap policies are
supplemental (or secondary) coverage. As an example, if you have a Medigap policy and go to
the doctor, he or she will send Medicare the bill. In most cases, Medicare will pay 80% of the
approved amount and then forward the 20% balance to the Medigap insurer, who will pay
some or all of the balance, depending on the plan that you have (Plan F, G, N, etc.).

From the patient’s perspective, this approach has several benefits. Because Medicare does not
have networks, you can go to any provider who accepts Medicare, as 99% of doctors and public
hospitals do. Also, Medicare makes the coverage decisions and not the insurance company – if
Medicare approves a procedure or treatment, the Medigap insurer cannot question the
decision. And Medicare is much more likely to approve some types of treatments than are
insurance companies.

In addition, Medigap policies are standardized and their benefit designs rarely change. Abd
because the benefits are the same regardless of the insurance company you buy your policy
from, you can focus on premiums. Advantage plans, on the other hand, often change their
benefit designs from one year to the next.

The chief downside of Medigap policies is their cost. Most Medigap plans, including the two in
your evaluation, are comprehensive plans, which means that they cover all or all of Medicare’s
gaps. With a comprehensive Medigap policy, then, almost all your cost for Medicare-covered
services will be in your premiums and there will be few co-payments.

If you get a Medigap policy, you will also need to enroll in a Part D stand-alone drug plan. And
Medigap policies do not cover routine dental and vision care or hearing aids – so you would
need to get a stand-alone plan for dental or vision coverage. See page 10 of the evaluation for
more information on buying a dental or vision plan. Both Medigap plans in your evaluation
include some benefits for medical emergencies while traveling outside the United States.

The benefit designs for all 10 Medigap plans are shown on pages 6-7. Here are summaries of
the two Medigap plans in your evaluation.

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