Page 3 - Evaluation for Norm Ross

that you’ll later be able to switch to a higher-level plan without having to answer questions
about your health.

Before choosing an insurance company to buy a Medigap policy from, it’s a good idea to get at
least three quotes and to choose a large company that has low premiums. Appendices B1
through B3 show the most recent premium comparisons from CSG Actuarial, with the lowest
premium companies listed first. You can use the comparisons as a starting point to identify the
insurers that have lower premiums and then call those companies to get current quotes.

Appendix B4 is Medicare’s list of insurers that sell Medigap policies in Maryland, including their
telephone numbers (the CSG Actuarial premiums do not include telephone numbers). All the
companies in Appendix B4 sell Plan F, but not all of them sell the other two plans in your
evaluation.

All your doctors accept Medicare assignment

In deciding which Medigap plan you might want, one factor to consider is whether your doctors
accept Medicare assignment. Providers who accept assignment agree to charge Medicare-
approved rates. And if they do not accept assignment, they can charge up to 15% more. Plan F
covers this additional 15% surcharge, but Plans N and L do not. In your case, this isn’t an issue --
Appendix A shows the Medicare web site’s printouts indicating that all five of your doctors
accept assignment.

The Medicare Advantage plan in your evaluation

There are only 14 Medicare Advantage plans in Frederick County (see Appendix C1) , six of
which are sponsored by Kaiser Permanente. As you may know, the Kaiser Permanente plans
require you to use their staff physicians, and so I didn’t consider these to be viable choices even
though they are highly rated plans.

That leaves eight other plans -- four HMO’s and four PPO’s. I chose the Johns Hopkins
Advantage MD Plus PPO plan for your evaluation because it has the lowest costs of any option
for your prescription drugs and it has a sizable network of more than 10,000 providers.

But this plan also has some weaknesses. Only two of your physicians are listed in its provider
directory – Drs. Levine and Liotta. And while you will be covered when you go outside the
network, you will usually pay 30% of the cost. Sometimes the provider directories are out of
date, and it’s possible one or more of the three unlisted doctors is in the network. Either way,
before enrolling in an Advantage plan you should verify which of your doctors are in the plan’s
network. Probably the easiest way to find out is to call their offices and ask.

Another concern is this plan’s below-average Medicare quality rating of 2.5 stars, which means
that the plan has not scored well on various quality measures, perhaps including customer
satisfaction. The quality ratings are a composite of almost 50 measures that Medicare uses to

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