Page 4 - Cover Letter and Evaluation for Steve DIckhaus

for the prescription drug that you take, as discussed in the Rx drug section. Both of your
physicians are in the HealthPartners network but before enrolling in this plan you should verify
with their offices that they accept this specific plan. Sometimes the online directories that we
use are out-of-date, and we always suggest that clients verify that their doctors are in the
network of the plan they want to enroll in. Because this a PPO plan, you would still be covered
when you see your doctors if they were out-of-network, but you would pay 40% of the cost.

As you can see from the comparisons on pages 2-3 of the evaluation, your fixed costs in this
plan are zero but your risk is high because of this plan’s $5,700 out-of-pocket limit for network
services. That’s the tradeoff people make when they enroll in an Advantage plan – they pay low
or zero premiums as a condition of accepting more risk.

One option you might consider is to enroll in this plan until you move to another state. When
you move out of an Advantage plan’s service territory, you have a brief special enrollment
period to buy certain Medigap policies in the state you’re moving to without answering
questions about your health. In your new state, of course, you will have eight Medigap plans to
choose from, but the special enrollment period applies only to specific plans. Attached to this
letter is Medicare’s explanation of this special enrollment period.

If you use this option, it would be a good idea to talk to the Medicare counseling agency of the
state you will be moving to. Ask them which Medigap plans you will be eligible for in their state
(since you will not be eligible for Plan F). To talk to a local counselor, call 800-MEDICARE and ask
for the number of the Medicare counseling agency in the state you’re moving to.

Rx Drug Coverage

Your Rx drug costs will be low regardless of the option you choose. The Medicare Plan Finder
does not list the 200mg dose of Allopurinol that you specified, so I chose the 100mg dosage and
doubled the monthly quantity from 30 to 60 tablets. The Plan Finder often does not list every
available dosage, and so if you’re already taking a 200mg tablet it’s likely that the Medicare
drug plan you enroll in will include it as an option.

If you decide to get a Medigap policy, you will need to enroll in a Medicare prescription drug
plan, also called a stand-alone drug plan. The lowest cost stand-alone plan for Allopurinol is the
Wellcare Wellness Rx prescription drug plan (its benefit summary is in Appendix C). Walgreens
is not a preferred pharmacy in this plan, and you will get the best pricing if you get your
prescriptions filled at a Walmart pharmacy. Your 12-month costs in the Wellcare Wellness Rx
are $165.60, including premiums and co-payments. If you get your refills at Walgreens, the cost
would be $96 more, or $261.60.

If you choose one of the Advantage plans, your drug coverage will be included in the plan’s
benefits. In the HealthPartners Journey Pace PPO Plan, your annual Rx drug costs are $79.20 if
you get your prescriptions filled at Walgreens. This plan may not have any preferred
pharmacies in your area, although the only way to know for certain is to call the plan.

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