Page 5 - Cover Letter and Evaluation for Susan Marx

Following are brief descriptions of these two Advantage plans, and their benefit summaries are
in the appendices.

• The Aetna Medicare Value PPO Plan. This plan has the lowest costs for your
drugs of any of the Advantage PPO plans in your area, and as mentioned it is
highly rated by Medicare for its quality of care. Its noticeable weakness is a
$1,000 medical deductible. The only medical services that the deductible does
not apply to are recommended preventive tests, which Medicare requires
Advantage plans to cover at 100% of cost. But with that exception, you will pay
the full cost of doctors’ office visits and other medical services until the
deductible is met.

Because you would be enrolled in this plan for only eight months this year, the
$1,000 deductible is equivalent to paying a $125 monthly health premium (it
would be less if you did not spend the entire deductible amount). In other
respects, it appears to be a good fit, i.e., your physicians are in its network, it has
low costs for your Rx drugs, it has an excellent quality rating, and so forth. And
unlike an HMO plan, it provides some coverage if you want to see an out-of-
network doctor. This plan’s benefit summary, including its costs for your Rx
drugs, is in Appendix C2.

• The UPMC for Life HMO Premier Rx Plan. This is also a highly rated plan that has
your doctors listed in its provider network, as shown in Appendix C5. Its $6,000
out-of-pocket limit for medical costs is high for an HMO, but it has no medical
deductible and a good benefit package. Its costs for your Rx drugs are the lowest
of any of the options available in your area.

As you know, HMO plans can be restrictive. You may need to get referrals from
your primary care doctor before you can see a specialist, although some HMO
plans now waive that requirement in specific situations. This plan’s benefit
summary, including the costs for your Rx drugs, is in Appendix C4.

Rx Drug Plan Coverage

Please verify that the drugs, dosages, and monthly quantities that I entered in Medicare’s Plan
Finder program are accurate – these are shown as an attachment to this letter. These are the
drugs, dosages, and monthly quantities used by the Plan Finder to estimate your Rx drug costs
in each plan.

The costs shown by Plan Finder assume you will be enrolling on the first day of the coming
month (April 1, in your case). Your costs will be slightly less because your enrollment won’t
begin until May 1. Another reason they will be slightly less than those shown is that you get
mail-order refills and, if you order your drugs at the start of May, you will have a one-month

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