Page 4 - Cover letter and evaluation for Michele Buros

out of network. So, in most cases there is little or no financial benefit to remaining in
the network. That’s a good deal when your providers are not in the network but
could be expensive relative to other plans when they are in the network. To
illustrate, in a PPO plan it’s unusual to have to pay 20% of the cost when you see a
network provider – instead you will usually have fixed and fairly low co-payments.

4) Aetna Medicare Gold PPO Plan. For someone in good health, this plan is the least
desirable of the four plans that are compared. It has annual health premiums of
$1,571 and a $500 health plan deductible. It also has the highest Rx drug costs of the
four options. Its good points are that both of your doctors are listed in its network, it
has a substantially lower out-of-pocket limit than the other three plans, and it offers
better dental and vision benefits.

This plan might be suitable for someone who expects to go to their doctors
frequently or to have expensive tests and treatments. Even in that case, though, it
likely that someone would save money by choosing a Medigap policy combined with
a stand-alone drug plan.

As you know, you can change Advantage plans each year during Medicare’s annual open
enrollment period (October 15 – December 7), with your new coverage going into effect
January 1. Medicare Advantage plans cannot deny coverage or charge more to people with
health problems, the only exception being individuals with end-stage renal disease. But it’s
unlikely that you would need to change plans in most years – only if your Rx drug costs rise
sharply or if one or more of your doctors leaves your plan’s network.

Please let me know if you have any questions. There are a couple of things to keep in mind as
you make the transition to Medicare for your primary coverage. On your initial visits to your
new doctors after March 1, show the office staff your enrollment cards for Medicare A&B and
the Advantage plan that you’ve selected.

And on your first visit to the pharmacy, show the pharmacist the enrollment card for the plan
you’ve chosen. That will help to avoid any later billing confusion. Also, you’re entitled to a free
“Welcome to Medicare” physical (see page 8 of the evaluation), but you’ll probably have to
request it.

Sincerely,

David Armes, CFP®

Attachments and Appendices

WDA:12115

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