Page 3 - Cover Letter and Medicare Evaluation for Vic Bosiger

Moreover, some PPO plans may consider referrals made by an out-of-network doctor as out-of-
network costs. As an example, if a non-network doctor refers you for a lab test, then the test
may be considered as an out-of-network cost even if it’s provided by a laboratory that’s in the
network. While that’s not the case with many PPO plans, it’s something you may want to check
before enrolling.

Below are summaries of the three Advantage plans that are compared in your evaluation. All
three have zero premiums for both health and Rx drug coverage. Besides having no premiums,
all three plans provide some worldwide coverage for medical emergencies as well as limited
dental and vision coverage. It is a good idea to check with your dentist and optometrist to make
sure they accept the plan’s dental coverage.

Here are brief summaries of each plan, and the plan’s benefit summaries are in the appendices.

1) AARP Medicare Advantage Choice Plan 1 (HMO-POS). This plan has Medicare’s highest
quality rating – five stars. It is not easy for a plan to earn a five-star rating, and only a
few Advantage plans in the country earn this rating each year. The rating is based on
several clinical measures including the plan’s customer satisfaction level.

In addition, Medicare has a special enrollment period for five-star plans. If you initially
enroll in another Advantage plan, you can switch to a five-star Advantage plan in your
area at any time during the year without having to wait for annual open enrollment. As
an example, if next summer your primary care doctor left the network of the Advantage
plan that you’re enrolled in, you could use this special enrollment period to switch to a
five-star plan if one is available in your area (you can do this only once a year).

As you may know, an HMO-POS plan is an HMO that has a point-of-service option that
allows you to be covered for specific out-of-network services. In this plan, the POS
option may be that you can go to an out-of-network dentist and have coverage. The
plan representative with whom I spoke said she believed that was what the POS option
meant, but she didn’t know for sure. Your insurance agent may be able to give you more
information about how the POS option works in this plan.

It’s probably best to think of this plan as a traditional HMO in which you have coverage
only when you remain in the network (except in emergencies). In many HMO’s, you may
need referrals from your primary care doctor before you can see a specialist.

One weak point is this plan’s $5,900 annual out-of-pocket limit for medical services,
which is high for an HMO (the PPO plan in your evaluation also has a $5,900 OOP limit,
but PPO’s usually have higher limits). So, even though you won’t pay any premiums in
this plan, you will have a fair amount of risk if you need expensive medical services.

Among this plan’s attractive features is a zero co-pay for office visits to your primary
care doctor (there’s a $40 co-pay to see a specialist). This plan includes limited dental

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