Page 2 - Cover Letter and Evaluation for Susan Marx

 If you decide to get a Medigap policy and a Part D stand-alone plan, you should
first decide which Medigap plan you want – Medigap Plan G or Medigap Plan N
or another plan. Then it’s a good idea to call three or more insurers and get
current quotes before deciding which company you’ll get your policy from.

 To enroll in the Part D stand-alone plan that has the lowest costs for your Rx
drugs, call the plan’s toll-free number, which is shown on page 4 of the
evaluation and in the Rx drug coverage section below.

The two Medigap plans in your evaluation

Two of the four options compared in your evaluation are Medigap policies – Medigap Plan G
and Medigap Plan N. And so It might be helpful to review certain features that all Medigap
policies share (you may already be aware of these).

Perhaps their most desirable feature is the flexibility they offer. There are no networks, and you
are covered when you see any provider who accepts Medicare (as some 99% of doctors and
public hospitals do). With a Medigap policy, you can go to virtually any doctor, public hospital
or clinic in the United States and be covered. Your three physicians all accept Medicare, as
shown in Appendix A.

Another strength of Medigap policies is that Medicare, not the insurance company, makes the
coverage decisions. And if Medicare approves a service or treatment, the Medigap insurer must
also cover it, up to policy limits. Because Medicare is more lenient in approving certain
treatments than are insurance companies, Medigap policyholders may in some cases be
covered for treatments that people in Advantage plans may not be (the insurance company
could say that the treatment is not medically necessary). For that reason, people with health
issues will typically choose to get a Medigap policy if they are comfortable paying its higher
premiums.

Medigap policies do not cover routine vision and dental care or hearing aids, none of which are
covered by Medicare. Also, with the exceptions of seldom sold Plan K and Plan L, they do not
have out-of-pocket limits, although that is rarely an issue because Medicare’s underlying
catastrophic coverage is strong. And some Medigap plans, including the two compared in your
evaluation, include coverage for foreign travel emergencies.

During the first six months that people have Part B, insurance companies are required to sell
them Medigap policies without asking health-related questions. But after that six-month
guaranteed issue is past, insurers in Pennsylvania and most other states can ask people about
pre-existing conditions and can charge higher premiums or in some cases deny coverage. That
means that in Pennsylvania and most other states, the only opportunity for people to get a
Medigap policy without being medically underwritten is the six-month period that starts at the
same time their Part B coverage begins.

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