Page 5 - Cover Letter & Evaluation for Michael Novotny

based on more than 30 measures of clinical compliance with standards as well as customer
satisfaction.

Below are summaries of the two plans compared in your evaluation:

1) Alignment Health Plan My Choice (an HMO). This plan has a large network of more than
10,000 providers, which gives you a wide choice of doctors if you need to see a specialist. And it
has very low co-payments for many medical services – examples are zero co-payments for
doctors’ office visits and a maximum $150 charge for a hospitalization. Also, its $3,400 out-of-
pocket limit is Medicare’s recommended limit. Despite Medicare’s recommendation, few
Advantage plans have OOP limits this low. And this plan includes some dental and vision
benefits. This plan’s detailed benefit summaries are shown in Appendix D2.

2) AARP Medicare Complete Secure Horizons Plan 1 (an HMO). This plan also appears to be a
solid choice, although its co-payments and cost-sharing amounts are somewhat higher than
those of the Alignment Health Plan My Choice HMO. In addition, it has a higher out-of-pocket
limit ($4,900) and nominally higher co-payments for doctors’ office visits. It offers supplemental
dental coverage for an additional premium, plus it has some benefits for routine vision care.

Rx Drug Plan Coverage

Even though you do not currently take prescription drugs, you are required to enroll in a Part D
plan or else face the risk of a lifetime late-enrollment penalty. If you purchase a Medigap policy,
the type of Part D plan you should get is a stand-alone drug plan. Since you don’t take any Rx
drugs, you should enroll in the stand-alone plan that has the lowest premiums – the Aetna
Medicare Rx Select Plan. It has a $19.70 monthly premium, or $236.40 a year. You can enroll in
this plan by calling 800-MEDICARE or the plan’s toll-free number shown on page 4 of the
evaluation. CVS is a preferred pharmacy in this plan, and if you need short-term prescriptions
filled you should get the best prices there.

If you enroll in one of the Advantage plans compared in your evaluation, you will get that plan’s
Part D coverage. In both plans there are no premiums for the Part D coverage, and so if you
don’t get any prescriptions filled you will have zero Rx drug costs. CVS is not a preferred
pharmacy in the Alignment My Choice plan, and if you need a prescription filled you will
probably get the lowest prices at a preferred pharmacy such as Costco or Healthy Living.

The AARP Medicare Complete Secure Horizons Plan 1 does not have preferred pharmacies, and
so in this plan you can go to any pharmacy that will accept this plan’s coverage.

Analysis

If you choose to enroll in either of the two Advantage plans compared in your evaluation, you
will likely save money, possibly a substantial amount. The tradeoff is that you will have to

5