Page 4 - Cover Letter and Evaluation for Paul Howell

when you need to find a new specialist or primary care doctor, you’ll have more choices. This
plan offers some dental and vision benefits.

As noted above, if you decide to enroll in an Advantage plan, after six months you will no longer
have a guaranteed right to acquire a Medigap policy until you turn 65. Even without the
guaranteed right, though, it’s possible you could get a Medigap policy later, but it will be
expensive.

Rx Drug Plan Coverage

The details of your prescription drug costs are shown in Appendix C (for the BlueAdvantage
Garnet PPO Plan) and in Appendix D2 (for the AARP Medicare Rx Saver Plus Plan). In both these
plans, Krogers is a preferred pharmacy.

If you decide to get a Medigap policy, you will need to get a Medicare prescription drug plan,
also called a stand-alone drug plan. The lowest-cost stand-alone plan for the drugs that you
take is the AARP MedicareRx Saver Plus prescription drug plan, with estimated costs of $3,653
for the last eight months of this year. That amount that includes premiums and co-pays. To
enroll in this plan, you can call (888) 867-5564.

In the BlueAdvantage Garnet PPO Plan, your estimated prescription drug costs for the last eight
months of 2020 are $3,238.

One of your drugs – the albuterol sulfate aerosol solution – is not on either plan’s formulary, as
indicated in Appendices C and D2. That means you will not only pay the plan’s full cost for this
drug, but your payments will not apply to the plan’s deductible. You can request what’s known
as a formulary exception, in which case your doctor will have to justify your need for this drug
vs. another drug that is on the plan’s formulary. Or you can find the lowest price available and
purchase this drug without insurance.

Also, you’d mentioned that you sometimes use discount coupons to save money on drug
purchases. Sometimes that can be a wise strategy, but Medicare’s complex Part D design makes
it difficult to know whether you are really saving money. Part D has four coverage levels – a) the
deductible, b) the initial coverage phase, c) the coverage gap/donut hole, and 4) the
catastrophic coverage phase. Depending on which phase your total drug costs are in when you
purchase a drug, its costs will be different.

In the AARP Medicare Rx Saver Plus plan, for instance, if you get the Breo aerosol powder at a
Krogers Pharmacy, you will pay $372.81 if the plan’s $435 deductible hasn’t been met. But that
drops to a $26 co-payment in the initial coverage phase, then jumps to $93.20 in the coverage
gap, and then drops again to $18.64 if you reach the catastrophic coverage phase (you won’t
reach that phase this year). The BlueAdvantage Garnet PPO Plan does not have a deductible,
and so it has only three coverage phases.

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