Page 4 - Cover Letter & Evaluation for David Steenburgen

addition to discounts, some insurers provide additional benefits like membership in Silver
Sneakers, which give you access to more than 12,000 gyms and health clubs nationally.

Medicare Select plans

A Medicare Select plan is a type of Medigap policy that has a network, and in some ways it is
like a PPO. When you go outside the plan’s network, you will still be covered but will pay more.
As a tradeoff for the network restrictions, Medicare Select premiums are generally 10% to 15%
lower than those of standard Medigap policies. Attached to this letter is a brief description of
how these plans work.

In Arizona, two large insurance companies – AARP and Blue Cross Blue Shield of Arizona (BCBS)
sell Medicare Select policies (there may be others that do as well, but these are the two largest
and most prominent companies that sell them). AARP sells two Medicare Select plans and BCBS
sells four Medicare Select plans.

The AARP Medicare Select plans: The two Medicare Select plans that AARP sells are Plan F and
Plan C. These two plans have a network of hospitals where you will be fully covered. In Pima
County, there are seven hospitals in the AARP network, listed in Appendix C1. Also, in case of an
emergency, you will have full coverage regardless of the hospital you go to.

But if it’s not an emergency and you go to an out-of-network hospital, you will be responsible
for the $1,340 Part A deductible. Premiums for someone your age in AARP’s Select Plan F are
just over $191 a month (almost $2,300 a year). In AARP’s Select Plan C, annual premiums are
about $32 less than for Plan F. The only difference in these two plans’ benefits is that Plan F
covers excess charges by doctors who do not accept Medicare assignment and Plan C does not.
As mentioned earlier, Dr. Sameshima accepts assignment.

The BCBS of Arizona Medicare Select plans: The four Medicare Select plans that BCBS sells are
Plans C, D, G, and N. BCBS designates these Medicare Select plans as “Senior Preferred” plans.
In these four Senior Preferred plans, unless it’s an emergency you must go to one of the
15,000+ providers in the BCBS network to have full coverage. According to Appendix C2, Dr.
Sameshima is listed in the BCBS network, but you should verify that prior to acquiring a BCBS
Senior Preferred plan.

If you go to an out-of-network doctor in one of the BCBS Senior Preferred plans, you will not
have any supplemental coverage for that visit or treatment (again, emergencies are
exceptions). But Medicare’s underlying coverage, which typically pays 80% of the cost, will still
be in place, and you would owe only the 20% balance.

With Medicare Select plans, the risk is that you will need to go outside the network in a non-
emergency situation. In the BCBS Medicare Select plans, for example, you might want to see a
specialist who is not in the BCBS network, or Dr. Sameshima could leave the network. In that
case, you might be able to switch to a standard Medigap policy, but you would likely have to

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