Page 3 - Cover Letter and Evaluation for Paul Dorroh

Many insurers offer a discount when both spouses buy a policy. This household discount can
range between 3% and 12%, depending on the company.

Even if you do not start out with a Medigap policy, if you later gets a policy from the same
company that issues your wife’s, you will both be eligible for a discount if that company offers
one. The CSG Actuarial premiums show the amount of the household discount (as a percentage
of the premium), but the premiums listed do not include the discounts (although I can re-run
the premiums with the discounts included if you wish).

In addition to discounts, some insurers offer additional benefits such membership in Silver
Sneakers, which give you access to more than 12,000 gyms and health clubs nationally.
Appendix B3 lists the toll-free numbers of the companies that sell Medigap policies in Georgia.

Medicare Advantage plans

Advantage plans are managed-care plans – primarily HMO’s and PPO’s. Generally their
premiums are much lower than Medigap premiums, but their out-of-pocket limits can be high.
These plans are best suited for individuals in relatively good health – people with health
problems may find it challenging to deal with Advantage plans’ restrictions, including prior
approvals for some treatments. And people who see several physicians may not be able to find
an Advantage plan that has all of their doctors in network.

One of the best ways to control costs in an Advantage plan is to use the plan’s network
providers – doctors, hospitals, therapists, and so forth. Even though in an PPO plan you will be
covered when you see any doctor, you may have to pay 40% or more of the cost when you go
outside the network for a service or treatment, depending on the plan.

Both your physicians are listed in the networks of the plans in your evaluation (as shown in
Appendix A), but prior to enrolling in an Advantage plan, you should verify that with their
offices. That’s because sometimes the online provider directories are out of date.

As mentioned, the two Advantage plans compared in your evaluation are both sponsored by
Aetna and they share several good features – above-average four-star quality ratings from
Medicare, relatively large provider networks, zero premiums for both health and Rx drug
coverage, and no health plan deductibles.

For Advantage plans, it’s important to look at the plan’s quality rating, which is assigned by
Medicare based on almost 50 different measures that include clinical criteria and customer
satisfaction. The insurers who sponsor Advantage plans work hard to earn quality ratings of
four stars or higher because of the bonuses they receive (Part D stand-alone plans also earn
quality ratings from Medicare, but there are no associated bonuses and so the ratings are
generally lower and considered less important).

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