Page 3 - Cover Letter and Evaluation for Paul Howell

1) Medigap Plan G. This is a comprehensive plan that covers all the gaps in Medicare
except for the Part B deductible, which is $198 in 2020. Therefore, after you’ve
satisfied the Part B deductible, you will not have any co-payments or other cost-sharing
for Medicare-covered services.

2) Medigap Plan N. This plan is less comprehensive than Plan G but is still solid coverage.
Its gaps include the Part B deductible ($198 this year), co-pays of up to $20 for doctor’s
office visits, and a $50 co-pay for emergency room visits.

The pricing of Medigap policies

Appendices B2 and B3 show each insurance company’s premiums for Plan G and Plan N. These
premiums are according to CSG Actuarial, a firm that provides quotes for insurance agents. In a
few cases the premiums may not include commissions and are thus lower than you will be able
to get (there’s no way for me to know which ones these are).

In both these appendices, companies are listed according to their monthly premiums -- from
lowest to highest -- which makes it easier to identify the lowest-premium companies. And in
some cases the CSG Actuarial lists give you the insurers’ financial ratings. Phone numbers of the
insurance companies licensed to sell Medigap policies in Tennessee are shown in Appendix B1.

The Medicare Advantage plan in your evaluation

Medicare Advantage plans are managed-care plans – HMO’s and PPO’s, for the most part. In
Rutherford County there are 31 Advantage plans, and for your evaluation I selected the
BlueAdvantage Garnet PPO Plan, which is sponsored by Blue Cross Blue Shield of Tennessee.

Your three physicians are listed in this plan’s network, as shown in Appendix A2. But if you
decide to enroll in this plan, you should first verify with their offices that they are still in this
plan’s network.

This plan has several good features. It has the second-lowest costs for your Rx drugs of any
Advantage plan in your county. It has no premiums and no deductibles for either health or Rx
drug coverage and it has an above-average four-star quality rating from Medicare.

In Advantage PPO plans such as this one, one key to controlling your costs is to use only
network providers (doctors, therapists, labs, hospitals, etc.). if you use an out-of-network
provider, in most cases you will pay 50% of the cost, although emergencies are exceptions. And
if you use only network providers, the maximum you could pay for Medicare-covered services is
$6,700 a year – although it is unlikely you would pay that.

Although Medicare no longer lists the number of providers in an Advantage plan, this plan
appears to have a large provider network based on the size of its provider directory. In general,
large-network plans are preferable to plans that have smaller networks. The reason is that

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