Page 3 - Cover Letter & Evaluation for Blanca del Real

If you are interested in getting Medigap quotes, let me know and I will send you the list of the
insurance companies that sell these policies and their toll-free numbers – this information is
from the California Dept. of Insurance website. Then you can call two or three companies to get
current quotes.

One important point about Medigap policies is they do not include Rx drug coverage, and so if
you get a Medigap policy you will also need to enroll in a Part D stand-alone plan. Let me know
if you want to get a Medigap policy and I will also send you the names and enrollment phone
numbers of the Part D stand-alone plans that have the lowest costs in 2019 for the drugs that
you take. The lowest-cost Part D stand-alone plan for your Rx drugs next year will cost you $252
for the year, including premiums, deductible, and co-payments.

Medicare Advantage plans

Advantage plans are managed-care plans – primarily HMO’s and PPO’s. They are different from
Medigap policies and are not considered supplemental coverage. Instead of supplementing
Medicare, they replace it for as long as you are enrolled (Medicare assigns your benefits to the
plan). Advantage plans must follow Medicare’s coverage rules and provide the same overall
benefits as traditional Medicare, but they have some flexibility to impose restrictions and vary
co-payments between in-network and out-of-network providers.

Medicare pays the plans a monthly amount -- $900 a month, say – for each enrollee. These
amounts are adjusted for an enrollee’s age and health status. Because of these monthly
payments from Medicare, Advantage plans can offer attractive benefit packages that include
zero premiums for health and Rx drug coverage.

Before enrolling in an Advantage plan, you should verify with Dr. Roberts’ offices that she is in
the plan’s network -- occasionally the online directories that we use are out of date. According
to the current provider directories and as shown in Appendix A, she is in the networks of the
three Advantage plans that are compared in your evaluation.

In your zip code there are 42 Medicare Advantage plans that include prescription drug
coverage. These plans are listed in Appendix C1, where they are sorted by their annual costs for
the drugs that you take. There is only one Advantage PPO plan in Los Angeles County and it is
not a good option for you because of its high costs for the Rx drugs you take.

That leaves Advantage HMO plans. These plans are usually the least expensive options, but they
are also the most restrictive. As an example, you will likely need referrals from Dr. Roberts
every time you want to see a specialist. Some treatments and tests may require prior approval
by the plans. And unless it’s an emergency, in most case you will pay the full cost for any
medical care you receive from doctors who are not in the plans’ networks

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