Page 2 - Cover Letter and Evaluation for Russell Wild

It might help to review some features that all Medigap policies share (you may already be
aware of these). Their strongest point is the flexibility you will have in choosing providers. There
are no networks, and with a Medigap policy you will be covered when you see any provider
who accepts Medicare (as some 99% of doctors and public hospitals do).

With a Medigap policy, then, you can go to virtually any doctor, public hospital or clinic in the
United States and you’ll be covered. Your physicians accept Medicare-approved rates, as shown
in Appendix A (there are two physicians named David Smith in your area, and I included both).

You mentioned that you travel to other countries on occasion, and Plan G and Plan N have
some coverage for foreign travel medical emergencies. This coverage includes a $250
deductible for each event, after which the Medigap plan covers 80% of the balance, with a
$50,000 lifetime limit.

Another strength of Medigap policies is that Medicare, not the insurance company, makes the
coverage decisions. And if Medicare approves a service or treatment, the Medigap insurer must
also cover it, up to policy limits. Because Medicare is more lenient in approving certain
treatments than are insurance companies, Medigap policyholders may in some cases be
covered for treatments that people in Advantage plans may not be (the Advantage plan could
say that the treatment is not medically necessary). For that reason, people with pre-existing
conditions will typically get Medigap policies.

As we discussed, most Medigap policies do not cover routine vision/dental care or hearing aids,
none of which are covered by Medicare. It is possible that there are “innovative benefit”
Medigap plans in Pennsylvania that include limited dental/vision benefits. And with the
exceptions of Plan K and Plan L, Medigap policies do not have out-of-pocket limits, although
that is rarely an issue because Medicare’s underlying catastrophic protection is excellent.

During the first six months that people have Part B, insurance companies are required to sell
them Medigap policies without asking health-related questions. After this six-month
guaranteed issue period is over, insurers can ask applicants about pre-existing conditions and
can charge higher premiums or deny coverage (that’s also true when people try to switch their
Medigap policy to another company to get lower premiums).

Medigap premiums

To get current quotes, you will need to call the insurance companies that sell Medigap policies.
As mentioned, these companies’ phone numbers are in Appendix B1 (I believe I sent you a copy
of this list earlier). The companies’ premiums for Plans G, N, and L are n Appendices B2 through
B4. These premium comparisons are from CSG Actuarial, a firm that provides quotes for
insurance agents. They should be current, but in a few cases they may not include the agents’
commissions (there is no way for me to know which ones these are).

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