Page 3 - Cover Letter and Evaluation for Mary Beth Parsons

All your doctors accept Medicare assignment

In deciding which Medigap plan you might want, one factor to consider is whether your doctors
accept Medicare’s approved rates. Providers who accept Medicare’s rates are said to accept
assignment. Some providers accept Medicare but do not accept assignment, and in those cases,
they can charge up to 15% more than Medicare’s approved rates. Plan G covers this 15%
surcharge, but Plans N and L do not. In your case, this isn’t an issue because your three doctors
accept Medicare’s approved rates, as shown in Appendix A.

The Medicare Advantage plan in your evaluation

There are only 14 Medicare Advantage plans in Brazos County – 5 PPO’s, 1 HMO, 1 Private-fee-
for-service plan and 7 Medicare Cost Plans. Because one of your physicians – Dr. Hutton – is in
Houston, it is unlikely that any Advantage plan will have all three of your doctors in its network.

As you may know, in PPO plans as well as Medicare Cost plans, you can go to out-of-network
providers and be covered. But you will pay substantially more to see a non-network doctor. In
the Humana Choice Regional PPO plan in your evaluation, you will pay 40% of the cost when
you see Dr. Hutton. In the Medicare Cost plans, you will pay 20% of the cost for out-of-network
services. All 7 of the Medicare Cost plans in Brazos County have relatively high costs for your Rx
drugs, so I decided not to consider them.

People who live away from large metropolitan centers frequently do not have any good
Advantage plan choices. Nationwide the average county in 2018 has 21 Advantage plans,
compared to only 14 in Brazos County. Frequently the Advantage plans in rural areas tend to
have higher deductibles and more out-of-pocket risk. The Humana Choice Regional PPO Plan in
your evaluation, for example, has a $10,000 out-of-pocket limit for in-and-out of network
services combined and a $750 medical deductible.

There are two Humana Choice Regional PPO plans in Brazos County, each with a unique
number to identify the plan. For your evaluation I chose the Humana Choice Regional PPO Plan
# R4182-004. It has the lowest costs for your Rx drugs and also the lowest health premiums.
And it has a large statewide network of more than 20,000 providers. Drs. Berigan and Perkins
are listed in its provider directory, as shown in Appendix D2, but Dr. Hutton is not.

Rx Drug Plan Coverage

The Medicare web site has only one size for cholestyramine -- a can that contains 378 grams.
That doesn’t mean that you won’t be able to get other sizes, since the Medicare web site does
not always display all available sizes and dosage levels. The Medicare web site’s only choice is a
378-gram can and the only refill frequencies are 1 month, 2 months, 3 months, and 12 months.
I chose 3 months, but if you take only 3 or 4 doses a week of 4 grams each, one can may last
you four or possibly five months. Thus, the annual costs, which are based on 3-month refills of
this drug, are overstated, possibly by as much as $100.

3