Page 3 - Cover Letter and Cost Estimates for Ms. LaVerne Durham

As you can see in the separate attachment, premiums for the same plan vary widely, and so if
you do eventually get a Medigap policy, choose a company that has low premiums.

Medicare Advantage plans

Your estimates compare two Advantage plans. There are only 16 Advantage plans in
Montgomery County, as shown in Appendix B1. That number is less than one-half the national
average of 33 plans per county. None of the16 plans appears to be a good match for you. Four
of them are limited to residents of Erickson retirement communities, three are Kaiser
Permanente plans that require you to use Kaiser staff physicians, and two others are Advantage
Medical Savings Accounts, which are Medicare’s version of high-deductible health plans. As
noted, none of the plans’ networks include all your physicians, and the only Advantage PPO
plan on the list has a $351 monthly premium.

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

1) Johns Hopkins Advantage MD Plan (an HMO). Three of your doctors are listed in the
plan’s network. This plan has a $40 a month medical premium, but no premium for Rx
drug coverage. Office visits to a network primary care doctor require a $5 co-payment,
but that amount jumps to $50 if you see a specialist. Hospital costs are $310 a day for
days 1-5 in a network hospital, and days 6-90 have no additional cost. This plan does
have some limited dental and vision benefits and also offers a more comprehensive
dental plan for a $30 monthly premium. Its Medicare quality rating is 3.5 stars, which is
considered average.

2) CareFirst BlueCross BlueShield Advantage Core Plan (an HMO). This plan has only two
of your five physicians listed in its online network directory. Co-payments for doctors’
office visits are the same as in the Johns Hopkins plan -- $5 to see a primary care doctor
and $50 to see a specialist. This plan’s hospital costs are slightly more expensive than
those of the John Hopkins plan, and its dental and vision coverage appear to be slightly
worse. This plan is too new to have a quality rating from Medicare.

Rx Drug Plan Coverage

As mentioned, your drug coverage is included in your Advantage plan’s benefits, but if you get a
Medigap policy you will also need to enroll in a stand-alone drug plan. The Medicare Plan
Finder program is the only way to identify the lowest-cost plans for a particular drug regimen,
and by default it assumes your coverage will begin on the first day of the next month –
September, in this case. So, your estimated drug costs shown in the appendices are for the last
four months of this year, and I multiplied that number by three to get an approximation of your
annual costs in 2021.

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