Page 1 - Cover letter and evaluation for Darlene Hoover

November 8, 2018

Mrs. Darlene Hoover
210 Estero Rd.
Fort Wayne, IN 46845

Dear Mrs. Hoover:

Your Medicare evaluation is enclosed. Please check the information on the client data sheet on
page 5 to make sure it is correct. Your evaluation compares four options – two Medigap plans
and two Advantage plans.

These same four options in your evaluation may also be good choices for your husband
because, as shown on the attachment to this letter, his doctors are listed in the Advantage
plans’ networks. Also, the four plans compared in his evaluation may be good choices for you,
giving you eight possible options that may be well suited to your needs.

The Medicare web site indicates that all your doctors accept Medicare-approved rates, as
indicated in Appendix A. When a doctor does not accept Medicare-approved rates, he or she
can charge up to 15% more. Neither of the Medigap plans in your evaluation covers this extra
charge, but since all your doctors accept Medicare-approved rates, it isn’t an issue.

The four options in your evaluation

You indicated that you would like to see comparisons of Medigap policies as well as Medicare
Advantage plans. Your evaluation compares two Medigap plans (Plan N and Plan L) and two
Medicare Advantage plans, one an HMO and the other a PPO.

Medigap policies

It might help to explain how Medigap policies work, including their strengths and weaknesses,
and the ways that they are different from Medicare Advantage plans. Medigap policies are
supplemental (or secondary) coverage. When you have a Medigap policy and go to the doctor,
he or she will send Medicare the bill. Then in most cases, Medicare will pay 80% of the
approved amount and forward the 20% balance to the Medigap insurer, who will pay some or
all of the balance, depending on the plan that you have.

From the patient’s perspective, this approach has several benefits. Because Medicare does not
have networks, you can go to any provider who accepts Medicare, as 99% of doctors and public
hospitals do. Also, Medicare makes the coverage decisions and not the insurance company – if
Medicare approves a procedure or treatment, the Medigap insurer cannot question the