Page 4 - Cover Letter and Evaluation for Paul Dorroh

In DeKalb County there are 25 Advantage plans that include drug coverage, but only eight have
quality ratings of four or more stars, and except for the Aetna and Kaiser Permanente plans,
they all have annual prescription drug premiums that exceed $325 -- more than you should pay
since you do not regularly take any drugs.

Here are summaries of these two plans:

1) Aetna Medicare Essential Plan (Local PPO). This plan’s network of more than 9,000
providers gives you a wide choice if you need to see a new specialist or other provider.
And its costs are low if you remain in the network -- $9 for a primary care doctor’s office
visit and $40 for a visit to a specialist. Its out-of-pocket limit is $5,900 if you remain in
network but then jumps to $10,000 for combined in-and-out of network services.

Also, some out-of-network costs are high – as an example, in this plan you will pay 40%
of the cost if you go to a non-network hospital unless it was an emergency. This plan
also has limited benefits for dental, vision, and hearing care, none of which are covered
by Medicare.

2) Aetna Medicare Select Plan (HMO). As you know, HMO’s are the most restrictive type
of managed-care plan. Usually you need referrals from your primary care doctor when
you want to see a specialist and you are not covered when you leave the network unless
it’s an emergency.

On the plus side, HMO’s are the most popular type of Advantage plan, with roughly two-
thirds of all Advantage enrollees in one of these plans. And because they are tightly
restricted, they can coordinate care more easily than can PPO plans. This plan appears
to have the same 9,000+ provider network as the other Aetna plan, again giving you a
wide choice of specialists. Its out-of-pocket limit is $5,650, and its co-pays are $5 for a
doctor’s office visit to your primary care physician and $35 to your specialist.

Additional benefits for dental, vision, and hearing

Some Advantage plans provide benefits for services that Medicare (and Medigap policies) do
not cover. The Aetna Medicare Essential Plan described above has some benefits for routine
dental and vision care, but the Aetna Medicare Select Plan has them only for vision care.

As shown in Appendix D2, the Aetna Medicare Essential Plan appears to cover an oral exam,
teeth cleaning, and dental x-ray with zero co-pays, although there may be limits on how much
the plan will pay. In addition, a routine eye exam, eyeglasses, and contacts are covered.
You mentioned that you have a separate policy for dental/vision coverage, and if you decide to
enroll in the Aetna Medicare Essential Plan, you might check to see if you still need your stand-
alone dental/vision plan (your wife could keep hers).

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