Page 2 - Cover letter and evaluation for John Johnson

Your physicians’ network affiliations

All your physicians accept Medicare-approved rates (see Appendix A). A doctor may accept
Medicare but not accept Medicare-approved rates, and in those cases he or she can charge up
to 15% more than the approved rates. Medigap Plans F and G in your evaluation cover the
added charge but Plan N does not. Since all your medical doctors accept approved rates, this
isn’t an issue. For future refence, in those cases in which a doctor accepts Medicare but does
not accept Medicare-approved rates, he or she can charge only 15% more than the approved
rates. In most cases that turns out to be a few dollars, although for expensive treatments it can
be substantial.

I was unable to find an Advantage plan that lists all your physicians in its network. Because you
see several physicians, it is unlikely that any Advantage plan has all of them in its network. I did
look at the directories of three Advantage PPO plans that have large networks of more than
20,000 providers – Aetna, Blue Cross, and Humana. A provider may be a doctor, a medical
group, a hospital, a skilled nursing facility, a physical therapy/rehab center, and so on.

Among the plans I looked at, the Aetna Medicare Choice PPO Plan has the largest number of
your doctors in its network, with only Drs. Chapman and Luk not listed. In some cases, the
online provider directories are out of date, and so if you are interested in this plan you should
verify with these doctors’ offices whether they accept the Aetna Medicare Choice PPO Plan.

The three Medigap plans in your evaluation

Before summarizing the three Medigap plans in your evaluation, it might be helpful to review
certain features that all Medigap policies share (you may already be aware of these).

Perhaps most important, these policies can be purchased during the first six months you have
Part A and Part B without your having to answer health-related questions. But after that six-
month period has past, if you want to acquire a Medigap policy, you will likely have to answer
questions about you can get a policy. People who have serious health issues may not be able to
get a Medigap policy or upgrade from a less comprehensive to a more comprehensive Medigap
plan after this initial six-month period.

One desirable attribute of Medigap policies is the flexibility they offer. There are no networks,
and so you will be covered when you see any provider who accepts Medicare (as some 99% of
doctors and public hospitals do). That means you can go to virtually any doctor, hospital or
clinic in the U. S. and be covered.

Another plus is that with Medigap policies, insurance companies do not make coverage
decisions. If Medicare approves a service or treatment, the Medigap insurer must also cover it.
And because Medicare is more lenient than are insurance companies, Medigap policyholders
may in some cases be covered for services and treatments that people in Advantage plans will

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