Page 2 - Cover Letter and Medicare Evaluation for Barbara Pender

Dr. Tint’s network affiliations

As indicated in Appendix A, Dr. Tint accepts Medicare and is also in the networks of both
Advantage plans in your evaluation. Before enrolling in an Advantage plan, though, it’s a good
idea to verify with her office that she is still in the plan’s network, since occasionally the
network directories are out of date.

Also, you might see if she is any of the Wellcare Advantage plan networks. According to the
Wellcare provider directory, she is not in the network nor is the Memorialcare group she
belongs to. But it wouldn’t hurt to check, and if she is in any of the Wellcare networks I’ll be
glad to add that plan to her evaluation. Wellcare has several five-star Advantage plans in
Orange County, and there aren’t many Advantage plans in the country that have five-star
ratings.

How do Medigap policies work?

Medigap policies are supplements to traditional (original) Medicare. If you have a Medigap
policy and go to your physician, he or she sends the bill for your visit to Medicare, which pays
the physician what it owes (usually 80%) and then forwards the 20% balance to the Medigap
insurer. The insurance company then sends a check to the physician for what it owes, and if
there is a remaining balance, the physician’s office will bill you for that amount.

Some positive features of this type of coverage are: first, you can go to any medical provider in
the United States who accepts Medicare (as 99% do). You do not have to be concerned about
whether a provider is in a plan’s network – only whether the provider accepts Medicare. And
you do not need to get referrals from your primary care doctor before you can see a specialist,
as often is the case with Advantage HMO plans.

Since Medigap policies cover you when you go to any doctor who accepts Medicare, they are
the best option for people who travel within the U. S. often or who have a vacation home in
another area. Moreover, if you plan to travel to other countries, the two Medigap plans in your
evaluation both include some coverage for medical emergencies while traveling abroad. This
coverage has a $250 deductible, after which the Medigap policy will pay 80% of the cost, with a
$50,000 lifetime limit. The two Advantage plans in your evaluation also indicate that they have
some worldwide emergency coverage, but no details are provided.

Another strong point is that if you have a Medigap policy, Medicare (and not an insurance
company) makes the decisions about whether a service or treatment will be covered. And if
Medicare agrees to cover something, the Medigap insurer cannot decline coverage. Medicare is
more lenient in approving certain treatments and procedures than are insurance companies,
and for that reason people with serious pre-existing conditions will typically get a Medigap
policy if they can afford it.

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