Page 4 - Cover Letter and Evaluation for Dr. Jim Fisgus

some 99% of doctors and public hospitals do). That means you will have the ability to go to
virtually any doctor, hospital or clinic in the U. S. and be covered.

In addition, with Medigap policies insurance companies do not make any coverage decisions. If
Medicare approves a service or treatment, the Medigap insurer must also cover it. And because
Medicare is more likely to approve some types of treatments than are insurance companies,
Medigap policyholders may be covered for these treatments whereas people in Advantage
plans will likely not be. As an example, Medicare covers large numbers of clinical trials, but
Advantage plans usually do not cover them.

Except for the rarely sold Plans K and L, Medigap policies do not have out-of-pocket limits, but
because Medicare’s catastrophic coverage is very good, the absence of an OOP limit is not a
major concern. One analysis a few years ago indicated that fewer than 1% of all Medicare
enrollees would benefit from an OOP limit.

Neither Medicare nor Medigap policies cover routine dental and vision care or hearing aids.
Both plans in your evaluation do include, though, some benefits for medical emergencies while
traveling outside the United States (as shown on pages 6-7). Following are short summaries of
the two Medigap plans compared in your evaluation.

1) Medigap Plan G. This plan covers all of Medicare’s gaps except for the $185 Part B
deductible. That means almost the entire cost of your medical coverage is in your Plan G
and Part B premiums. The only Medigap plans that are slightly more comprehensive
than Plan G are Plans F and C, neither of which will be sold after this year. You can likely
get Plan G for $2,150 a year or less.

2) Medigap Plan N. This is a slightly less comprehensive plan than Plan G and it has some
small gaps (pages3 and 6-7 show where these gaps are). People in relatively good health
who don’t go to their doctors frequently will likely save $200-$300 a year in this plan
compared to choosing the higher-premium Plan F. Estimated annual premiums are
$1,800 a year.

These are not the only good Medigap plans, of course, and you might want to check pages 6-7
of the evaluation to see the benefit designs of all 10 Medigap plans.

The pricing of Medigap policies

It’s good to give some thought as to the company that you will buy your policy from and to
make a few calls to get current quotes. While it’s important to choose a company that has
relatively low premiums, you may also want to factor in a company’s financial strength and size.
As a rule, larger companies have slightly lower annual premium increases, according to a
government study a few years ago.

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