Page 5 - Cover Letter and Medicare evaluation for Mr. Rod Fallow

premiums or deductible for medical coverage, and a very low out-of-pocket limit of
$1,999 for medical costs. It also has some basic dental benefits as well as a dental
supplement that can be purchased for $29 a month. This plan’s benefit summary is in
Appendix C2.

2) UnitedHealthcare Medicare Advantage HMO Assure Plan. This 4-star plan has a few
good features but also noticeable weaknesses – most prominently a 20% co-insurance
payment to see a network doctor and a very high $7,550 out-of-pocket limit for medical
services. This plan’s benefit summary is in Appendix C3.

Rx Drug Plan Coverage

If you want, you might be able to enroll in a plan effective December 1. If that’s possible, one
benefit is that it may slightly reduce your Part D late-enrollment penalty, which is assessed at
1% a month for every month someone enrolls late. Typically, Medicare’s open enrollment
period is for people who want to switch plans at the end of the year, but since you do not
currently have any supplemental coverage, you may be allowed to start on December 1. Also, if
you have had any creditable drug coverage since you turned 65, that might reduce the amount
of the late enrollment penalty.

Most Part D plans do not cover tadalafil, and the few that do have a prior authorization
requirement. That means that plans can charge whatever they want for tadalafil, and when I
included it in your drug plan search, it distorted the results enough that a high premium plan
turned out to be the best choice. So, the costs shown below are based only on metformin (500
mg, taken daily). After you’ve enrolled in a plan, you can request either a formulary exception
or a prior authorization for tadalafil, although even if it’s approved you may still save money by
getting it without insurance.

The SilverScript SmartRx Prescription Drug Plan (PDP) is the lowest-cost option for the
metformin dosage – it will cost $101 next year, including premiums. CVS is a preferred
pharmacy in this plan. If you can enroll in this plan for the month of December this year, it will
cost $7.20 for the month.

In the Avo Advantage Plan, you will pay $27 next year, and $376 in the UHC Assure plan.

Rod, please let me know if you have any questions. There are a couple of things to keep in mind
as you make the transition to Medicare as your primary coverage. On your initial visits to your
new doctors after your coverage goes into effect, show the office staff your enrollment cards
for Medicare A&B and the supplemental coverage you’ve selected. And on your first visit to the
pharmacy, show them the enrollment card for the drug plan you’re enrolled in. That will help to

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