Page 5 - Cover Letter and Evaluation for Nobuko Christy

should be aware that your premiums may rise more quickly than with many other insurers.
After you turn 75, the AARP premiums will likely increase more slowly.

In addition to discounts, some insurers provide extra benefits like health club memberships.

The Medicare Advantage Plan in your evaluation

The Aetna Medicare Choice Advantage PPO plan is not a particularly strong plan for this area,
chiefly because it has a $750 health deductible and fairly high Rx drug costs for someone like
you who takes only generic drugs. This plan’s strengths are a large network of more than
20,000 providers an above-average four-star quality rating from Medicare.

Because your health premiums are much lower in this plan than with a Medigap policy, you can
perhaps save a substantial amount in an Advantage plan. The tradeoff is that in exchange for
these lower fixed costs, you will be accepting more out-of-pocket risk, particularly if you
frequently see a non-network provider. In this plan, for instance, you will pay 40% of most out-
of-network costs. Medicare’s summary of this plan’s costs and benefits can be found in
Appendix D2.

Rx Drug Plan Coverage

As mentioned earlier, Medigap policyholders are required to have Part D stand-alone plans. The
two lowest-cost stand-alone plans for the Rx drugs that you take are the Envision Rx Plus
Prescription Drug Plan and the Aetna Medicare Rx Select Prescription Drug Plan.

For mail-order refills, the Envision Rx Plus Plan’s estimated annual costs are $279 and for the
Aetna Medicare Rx Select Plan they are $335. For the Envision Rx Plus Plan, the caveats are that
it has a below-average quality rating of two stars (three stars is considered average) and also
may require your doctor’s prior authorization for methotrexate. Usually prior authorizations are
not difficult to get -- in most cases the doctor sends a letter to the insurer justifying your need
for this drug instead of a different drug that the plan may suggest.

In the Aetna Medicare Choice PPO Advantage Plan, your estimated annual costs for mail-order
refills are $581. Mainly that’s a function of this plan’s $40.90 monthly Rx drug premium, which
is included in the $581.

Vons Pharmacy is a preferred pharmacy in all three of these options, so that when you need a
short-term prescription filled you will likely get the lowest prices there.

Finally, there are a couple of things to keep in mind as you make the transition to Medicare. On
your initial visits to your doctors after March 1, show the office staff your new enrollment cards
for Medicare A&B, your Medigap policy and your Part D stand-alone plan (or your Medicare
Advantage plan). That will help to avoid any billing confusion. Also, you’re entitled to a free

5