Page 1 - Cover Letter and Evaluation for Dr. Maury Rosenstein

December 17, 2018

Dr. Maury M. Rosenstein
430 Silver Maple Ridge, Apt. #6
Charleston, WV 23506

Dear Dr. Rosenstein:

Your Medicare evaluation is enclosed. Please check the information on the client data sheet on
page 5 to make sure it is correct. The costs shown in the evaluation include the standard Part B
premium, which is $135.50 a month in 2019. Part B premiums are higher for high-income
individuals -- the 2019 amounts are listed in Appendix D.

So that your Medigap policy will go into effect on January 1, you should acquire a policy within
the next week or so. Once you’ve determined the insurance company you will get your policy
from, you can sign up on the phone. After you enroll, the company will mail you your coverage
card indicating a policy effective date of January 1, 2019.

Usually people who get a Medigap policy must also enroll in a Part D stand-alone plan, but
because you have creditable drug coverage through your employer, you won’t need to do that.
If you later decide you want to enroll in a Part D stand-alone plan, we’ll be glad to find the
lowest-cost plans based on the drugs that you take (there’s no added charge for this because Rx
drug comparisons are a part of the evaluation).

The basics of Medigap coverage

You probably already know how Medigap policies work. If you are covered by Medicare and go
to the doctor, he or she treats you and sends the bill to Medicare, which in most cases pays
80% of the cost. Next, Medicare forwards the unpaid balance to the Medigap insurer, who pays
some or all that amount based on the plan you have.

With Medigap policies, then, you will be covered when you see any provider who accepts
Medicare (as 99% of doctors and public hospitals do). For that reason, they are ideal coverage
for someone who wants to see providers in different states and does not want to worry about
network restrictions.

A related benefit is that Medicare makes the coverage decisions, not the insurance company.
Medicare is more lenient than insurers in approving certain types of treatments. And if
Medicare covers a treatment or procedure, the Medigap insurer is required to cover it.