Page 5 - Cover Letter and Evaluation for Diann Weade

some flexibility to impose restrictions and vary co-payments between in-network and out-of-
network providers.

Before enrolling in an Advantage plan, you should verify with your doctors’ offices that they are
in the plan’s network -- occasionally the online directories that we use are out of date. We
couldn’t find Drs. Gabrek and Teel in any of these directories, probably because dental
providers are listed in separate dental plan directories.

In your zip code there are 20 Medicare Advantage plans that include prescription drug
coverage. These plans are listed in Appendix D1, where they are sorted by their estimated 2019
for the prescription drugs you are currently taking. The Rx drug costs that are shown include
premiums, deductibles, and co-payments.

Both Advantage plans compared in your evaluation are HMO’s. As you probably know, HMO’s
are the most cost-effective type of managed care plan, and people in good health can save
substantial amounts in them. For some people, the downside is that they can be restrictive – in
most HMO’s people must get a referral from their primary care doctor to see a specialist, and
tests and treatments often require prior approvals. Also, there is no coverage when you see an
out-of-network doctor unless it’s an emergency.

Here are summaries of the two Advantage plans compared in your evaluation.

1) Anthem MediBlue Plus Plan (an HMO). This is your current plan, and it has several
strengths – zero premiums and a zero deductible for medical coverage, an above-
average four-star quality rating from Medicare and a large network of more than 20,000
providers in select Indiana counties, which gives you a wide range of choices if you need
to go to a new specialist. Except for your dentists, your physicians are listed in this plan’s
network.

One area where this plan’s benefits are sub-par is its $4,900 out-of-pocket (or OOP) limit
for network services -- a high OOP limit for an Advantage HMO plan.

2) Humana Gold Plus Plan (an HMO) # 5619-051. This plan likewise appears to be a solid
choice – it has the same four-star quality rating as your current plan as well as zero
premiums and a zero deductible for health coverage. Although its network of 5,500+
providers is smaller than your current plan’s, its service territory is limited to the Fort
Wayne metro area and so it may have as many local providers as your current plan
(although there’s no way to know for certain).

This plan’s $3,400 out-of-pocket limit for medical services is better than average, and its
Rx drug costs are lower, as discussed below. Drs. Garrean and Mummert are listed in
this plan’s provider directory, as indicated on the first page of Appendix D3. But because
provider directories are sometimes out of date, it’s a good idea to verify this before
changing plans.

5