Page 4 - Evaluation for Norm Ross

assess plans’ clinical quality, their performance in giving patients Medicare’s recommended
preventive tests and so forth. Many people rely on these ratings when they are choosing an
Advantage plan, and roughly 75% of all Advantage plan enrollees are in plans rated four stars or
higher. Given Johns Hopkins’ stellar reputation for medical care, the current low ratings are
likely the result of this plan’s relative newness – this is the first year it has been rated – and the
fact that it is still learning how to coordinate care so as to conform to Medicare’s standards.

Finally, this plan has high out-of-pocket limits, which is not unusual for Advantage PPO plans. If
you were to use only network providers, the OOP limit is $5,900, but that number jumps to
$10,000 if you combine in- and out-of-network services. That does not include this plan’s
annual health premiums of $451.

Rx Drug Plan Coverage

As mentioned, if you buy a Medigap policy you will also need to enroll in a Part D stand-alone
plan. In 2018 the lowest-cost stand-alone plan for the drugs that you take is the Aetna
Medicare Rx Select plan, has an estimated annual cost of $2,032 next year. That includes the
plan’s premiums, its $405 deductible, and co-payments for your prescription drugs. Also, that
assumes you will get monthly refills at a local pharmacy since this plan does not have a mail-
order option. Walgreens is not in this plan’s network. To get the best prices, you would need to
get your refills at CVS, Giant Eagle, or Weis Pharmacies, as shown in Appendix D2.

If you want to continue getting mail-order refills, the lowest-cost stand-alone plan is the
SilverScript Plus Prescription Drug Plan, which will cost an estimated $2,147 in 2018. That’s
$115 more expensive than getting retail refills in the Aetna Medicare Rx Select plan.

Your prescription drug expenses will be much lower in the Johns Hopkins Advantage MD Plus
PPO Plan -- $1,334 if you get mail-order refills. In this plan, then, you’ll save almost $700 on
your prescription drug expenses compared to the lowest-cost Part D stand-alone plan.

Whichever plan you choose, you may want to ask if your prescriptions can be transferred from
your current plan – saving you the trouble of asking your doctors for new prescriptions. If you
change your refill schedule to monthly, then you’ll need new prescriptions.

Analysis

As you can see from the cost comparisons on page 3 of your evaluation, your fixed (or
minimum) costs will be $2,500+ less in the least comprehensive coverage – the Johns Hopkins
Advantage MD Plus PPO Plan -- plan than in Plan F, the most comprehensive coverage. But in
Plan F you will have no additional costs for Medicare-covered services, whereas in the Johns
Hopkins plan you will have various co-payments, including 30% of cost for most out-of-network
services. In the Johns Hopkins plan as you go to your doctors at get various tests and
treatments during the year, the cost savings between the two plans will narrow.

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