Page 5 - Cover Letter and Evaluation for Stephen Spero

The two Advantage plans compared in your evaluation have zero premiums and zero
deductibles for medical coverage. Both also include some coverage for medical emergencies
while traveling outside the country. Here are brief descriptions of these plans, whose benefit
summaries are in the appendices.

• The Anthem MediBlue Plus HMO Plan. If you decide to enroll in Advantage plan,
this one appears to be your best choice. So long as you remain in its network,
your out-of-pocket costs and risks are much lower than in the other Anthem plan
described below. This plan’s out-of-pocket limit for medical services is $3,400,
which is Medicare’s recommended OOP limit for Advantage HMO plans.

This plan has fixed co-payments for doctor’s office visits -- $10 for a visit to a
primary care physician and $35 for a visit to a specialist. Co-payment amounts
for other medical services are also reasonable, and in case you are hospitalized
your $295 daily co-payments for days 1-7 are typical for an Advantage plan.

Unlike the plan below, this plan does not include dental benefits, but does sell
supplemental dental insurance. It does, though, have some benefits for routine
vision care and eyeglasses. This plan’s benefit summary, including its costs for
your Rx drugs, can be found in Appendix C2.

• The Anthem MediBlue Coordination Plus HMO Plan. This plan carries much
greater risk than the plan above. For one thing, it has a $6,700 out-of-pocket
limit for medical services, which is the maximum allowed by Medicare. Also, if
you are hospitalized you will pay a $1,408 deductible (although if you were
hospitalized for five or more days it would cost less than in the plan above).

In an unusual twist for an Advantage HMO plan, you will also have 20% co-
insurance payments for doctor’s office visits and many medical services. This is
high-risk coverage. As an example, if you have surgery that costs $10,000, you’ll
pay 20% of that amount until you have reached the plan’s $6,700 annual OOP
limit. To put this in perspective, this 20% co-insurance is the same that that you
will pay if you have Part B and no supplemental insurance. This plan’s benefit
summary, including its costs for your Rx drugs, can be found in Appendix C3.

Rx Drug Plan Coverage

Please verify that the drugs, dosages, and monthly quantities that I entered in Medicare’s Plan
Finder program are accurate – these are shown on the first page of Appendix D1. Sildenafil is
not covered by Part D, and so it is not included in this list. In addition, Appendix D1 shows the
Medicare Plan Finder’s rankings of the plans by their costs for your drugs. As noted, the drug
costs shown here assume your coverage will begin August 1. But in your evaluation, these costs
have been adjusted to reflect the fact that your coverage will not start until October 1.

5