Page 5 - Cover Letter and Evaluation for Margaret Rockey

premium, which is included in your Rx drug costs. As with most other Advantage PPO
plans, you will save money if you use only network providers. Generally, PPO plans
make financial sense when no more than one of a patient’s providers is out of network,
when the patient sees that provider infrequently, and when the patient does not get
expensive treatments from the out-of-network provider.

The most you could pay for Medicare-covered services in this plan is $6,000 in network.
That out-of-pocket limit jumps to $10,000 for combined in and out-of-network services.
These limits are high but not unusual for an Advantage PPO plan.

There’s no cost for office visits to network primary care physicians and $40 co-payments
for office visits to network specialists – co-payments that increase to $35 and $70,
respectively, for out-of-network office visits. There is an optional dental plan that you
can get for a $38 monthly premium. But unlike the AARP Advantage HMO plan
described below, this PPO plan does include some dental benefits without the optional
package. Before getting the optional package, verify with Dr. Stroh’s office that he will
accept that plan. This plan’s benefit summary, including its prescription drug costs, in
Appendix C2.

2) AARP Medicare Advantage HMO Plan. This plan has slightly less risk than the AARP PPO
Plan above – its hospital coverage and its out-of-pocket limit are somewhat better, and
its co-payments are less for most medical services. The tradeoff is that you have less
flexibility in this plan and will be covered only when you see network providers (except
in emergencies). Also, in most HMO plans you will need a referral from your primary
care doctor in order to see a specialist.

In this plan, you can purchase supplemental dental coverage for $43 a month. Unlike
the previous AARP plan, there does not appear to be any dental coverage other than
with the supplemental dental plan. This plan’s benefit summary, including its
prescription drug costs, is in Appendix C3.

Rx Drug Plan Coverage

Please verify that the drugs, dosages, and monthly quantities that were entered in Medicare’s
Plan Finder program are accurate. They are shown in an attachment to this letter and were
used by the Plan Finder program to identify the lowest-cost plans for your drugs. .

Even though the plans compared in your evaluation are among the lowest-cost plans for your
drugs, none of them has the drug Qnasi on its formulary. When a drug is not a plan’s formulary,
you can still purchase it through the plan but you will often pay more than if you buy it without
insurance.

In the plans in your evaluation, the 10 gram, 80 mcg/act aerosol solution of Qnasi costs
approximately $290. If you can get it for less without insurance, there’s no benefit to buying it

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