Page 2 - Cover Letter and Medicare Evaluation for Rod Morgan

from (the phone numbers are shown in Appendix B1). When you enroll, specify that you
want your coverage to start on February 1, 2022.

Also, if you get a Medigap policy, you will also need to enroll in a stand-alone drug plan
(since Medigap policies do not include drug coverage). To do that, call the plan’s toll-
free number, shown on page 4 of your evaluation, and let the representative know you
want to enroll in the plan effective February 1, 2022.

Your physicians’ network affiliations

As shown in Appendix A, Dr. Dunn accepts Medicare-approved rates and is also listed in the
networks of the two Advantage PPO plans in your evaluation. Before enrolling in an Advantage
plan, however, you should confirm with his office that he is still in the plan’s network –
occasionally the network directories that we rely on are out of date.

The first two options in your evaluation are Medigap policies – Plan G and Plan N. Their
premiums are in Appendix B2 (for Plan G) and Appendix B3 (for Plan N). Appendix B1 includes a
list of the phone numbers of the insurance companies licensed to sell Medigap policies in
Colorado and also their premiums as of last summer.

How Medigap policies work

The most important thing to be aware of is that during the first six months that you have Part B,
you can get a Medigap policy without having to answer health-related questions. After that six-
month period guaranteed-issue period is past, in Colorado and most other states you will likely
have to answer questions about your health before you can get a Medigap policy or – if you
already have one – to upgrade from a less comprehensive Medigap plan to a more
comprehensive one, e.g., from Plan N to Plan G. And individuals with serious pre-existing
conditions may not be able to get a Medigap policy after the initial guaranteed-issue period.

Perhaps the most desirable attribute of Medigap policies is the flexibility they offer. There are
no networks, and you do not need referrals to see specialists. You will be covered when you see
any provider who accepts Medicare (as more than 99% of doctors and public hospitals do).

When you have a Medigap policy and go to a doctor or other medical provider, he or she will
send the bill for your visit to Medicare. Then Medicare pays the doctor what it owes – usually
80% -- and forwards the 20% balance to the Medigap insurance company that issued your
policy. After the Medigap insurer pays the doctor some or all the 20% balance, the doctor will
then send you a bill for any remaining amount that was not paid either by Medicare or the
Medigap insurance company.

One nice feature of this kind of coverage is that Medicare makes the coverage decisions, and
not an insurance company. When Medicare pays for a medical service or treatment, the

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