Page 5 - Cover Letter and Medicare Evaluation for Barbara Pender

Advantage plans in Orange County – perhaps the most of any county in the nation. The
competition among these plans as well as the county’s large number of potential enrollees
makes these plans among the most attractive in the country. You can see a partial list of the
highly rated plans that have no drug premiums or deductibles in Appendix C1.

If you enroll in either of the plans below, you will likely save a minimum of $1,000 a year for
Medicare-covered services – that’s compared to what you’ll pay for a Medigap policy and
stand-alone drug plan. It assumes you will use only the Advantage plans’ network providers.
Moreover, both plans offer some dental, vision, and hearing benefits (which most Medigap
insurers do not offer). And many Advantage plan include free health club memberships (some
insurance companies also include these memberships with their Medigap policies). Here are
brief summaries of each plan, and the plan’s benefit summaries are in the appendices:

1) SCAN Classic Advantage HMO Plan. This plan has numerous strong points, including a
Medicare quality rating of 4.5 out of 5 stars. Medicare’s ratings are based on more than
40 measures that track customer satisfaction and a plan’s adherence to clinical
standards. In this plan there are no co-payments for doctors office visits (primary care or
specialist) and no cost for hospitalizations. But the doctors and the hospital must be in
the SCAN Classic network (except in emergencies).

There is a very low out-of-pocket $499 out-of-pocket limit for medical services. Since
this plan has no health premiums or deductibles, that’s the most you will pay for in-
network medical services (not including any Rx drug costs). There are also some dental,
vision, and hearing benefits, but before enrolling you might verify with your dentist and
optometrist that they accept this plan, whose benefit summary is in Appendix C2.

2) Blue Shield Inspire Advantage HMO Plan. This plan has an above-average Medicare
quality rating of four stars. Like the SCAN Classic plan, there are no premiums or
deductibles and no co-payments for doctors’ office visits or hospitalizations if they are in
network (again, emergencies are exceptions). The maximum you can pay for network
health services is $799, which while higher than the maximum in the SCAN Classic plan is
still very low for an Advantage plan.

This plan has dental, vision, and hearing benefits, although there are small co-pays for
dental procedures. Blue Shield also sells dental supplemental plans for an added
premium – one plan has a $12.40 monthly premium and the other a $41.90 monthly
premium. As mentioned, before relying on this coverage you should see if your dentist
and optometrist accept this coverage. You can see a more detailed summary of this
plan’s coverage in Appendix C3.

Rx Drug Plan Coverage

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