Page 2 - Cover letter and evaluation for Michele Buros

plans that generate the highest commissions, not always to the plans best suited for the
enrollees.

On a different point, you may already be aware of the enrollment rule regarding Medigap
policies. When people first enroll in Part A and Part B, they have a six-month guaranteed issue
period when they can acquire a Medigap policy without answering health-related question.
After that six-month period has past, however, in Pennsylvania and most other states, they will
have to answer questions about their health before getting a current quote or being sold a
policy. And if they have serious pre-existing conditions, they may not be able to get a policy.
Most people, it is true, are able to buy a Medigap policy in later retirement if they wish to. And
even though you are going to enroll in an Advantage plan, it’s good to know about this rule.

Medicare Advantage plans

When choosing an Advantage plan, you will probably want a plan with reasonably low costs for
the Rx drugs that you take. Because you take only two inexpensive generic drugs, your co-
payments will likely be low in any plan, which means that you want a plan that does not have
high premiums for drug coverage.

While it’s true that you can see virtually any doctor in a PPO and be covered, costs are typically
much higher when you go outside the network. Also, Advantage PPO plans have higher out-of-
pocket limits that apply to out-of-network costs. Before enrolling, then, it’s important to know
whether your doctors are in the plan’s network.

The online provider directories that we rely on are occasionally inaccurate, as studies have
demonstrated. Moreover, Advantage plans can drop doctors from their networks at any time of
year. The best way to verify whether your doctors are currently in a plan’s network is to call
their offices and ask if they accept the plan you want to enroll in. Give the exact name of the
plan, since doctors may be in the network of some Humana Advantage plans, for example, but
not in others.

Ideally, PPO’s make the most financial sense when all your regular doctors are in the network.
Should you need to see a non-network provider, then, you have the flexibility to choose almost
any physician in the United States. And it’s often assumed that you should go outside the
network only to see specialists. Your primary care physician, the doctor you probably see most
often and the one most likely to order tests and treatments, should be in the PPO network.

The four Advantage plans compared in your evaluation share several good features – four-star
quality ratings from Medicare, large provider networks, and relatively low costs for your
prescription drugs. Their downsides vary according to the plan, but three of them have high
out-of-pocket limits that are at Medicare’s maximum allowable level. And the one with a lower
out-of-pocket limit has high premiums for health coverage. Details of each plan’s coverage are

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