Page 4 - Cover Letter and Medicare Evaluation for Neill McLauchlin

2) Medigap Plan N. This plan is slightly less comprehensive than Plan G but still provides
strong coverage. Its gaps include the $203 Part B deductible, co-pays of up to $20 for
doctor’s office visits, and a $50 co-pay for emergency room visits. Annual premiums are
roughly 25% lower than Plan G’s, and if you do not go to the doctor frequently you
would probably save money in this plan compared to Plan G. Annual premiums for Plan
N are about $1,100 a year (roughly $90 a month).

Comparing the two Advantage plans in your evaluation

Advantage plans’ best feature is that most of them have low premiums. As an example, the two
Advantage plans compared in your evaluation have zero premiums for medical and Rx drug
coverage. Also, many Advantage plans have lower costs for prescription drugs than the stand-
alone drug plan you will need if you get a Medigap policy. And many Advantage plans offer
some dental, vision, and hearing benefits – none of which are covered by Medicare or by most
Medigap policies.

Despite the low premiums, in a few cases you could wind up paying more in an Advantage plan
than you would with a Medigap policy. That’s because Advantage plans often have high out-of-
pocket limits. The two plans in your evaluation have out-of-pocket limits of $4,900 and $5,750
for medical services you receive from network providers. And you could pay even more if you
see doctors who are not in the plan’s network. While it’s unlikely you would spend this much in
a given year, you should be aware of the risk (to read more about how Advantage plans work,
see page 9 of your evaluation).

The two plans summarized below have the lowest mail-order costs for the drugs you take of all
the Advantage plans in Mecklenburg County, as shown in Appendix C1. Your two doctors are
listed in the networks of both these plans, as shown in Appendix A2. But before enrolling in
either plan, you should verify with your doctors’ offices that they still accept the plan, since
sometimes the network directories that we use are not up to date.

Both plans have the same dental, vision, and hearing coverage, but you might verify with your
dentist and optometrist that they accept this coverage. Here are brief summaries of the two
Advantage plans in your evaluation, both sponsored by Cigna. To enroll in either plan, you will
call (855) 980-3049.

1) The Cigna Preferred Medicare HMO Plan. This plan has earned a Medicare-quality
rating of 4.5 out of a possible 5 stars. That places it among the top 10% of Advantage
plans in the country. In this plan, office visits to your primary care doctor require no
co-payments while visits to specialists cost $20. Perhaps this plan’s weakest feature
is the $4,900 out-of-pocket limit for medical services, which is high for an HMO.

As you may know, in an HMO plan you will have no coverage when you go to a
provider who is not in the plan’s network, unless it’s an emergency. And you will

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