Page 1 - SAMPLE

March 7, 2017

Mr. John Doe
1234 Anywhere Street
Titusville, FL 32783

Dear Mr. Doe:

Your Medicare evaluation is attached. Please check the information on the client data sheet on
page 5 to make sure it is correct, and if anything there needs to be changed, let us know. In
most cases the costs shown in the evaluation are estimates for the entire 2017 plan year, even
though you will not enroll until May 1.

Because you have not begun receiving your Social Security benefits, you will not be
automatically enrolled in Parts A and B when you turn 65. You can enroll by calling Social
Security at 800-772-1213 to let them know you want to begin your Part A and Part B coverage
on May 1. You should receive your Medicare card within a couple of weeks after you call.

The evaluation compares four options -- two Medigap plans and two Medicare Advantage
plans. The Advantage plans include prescription drug coverage. Medigap policies, on the other
hand, do not include prescription drug coverage, and if you decide to get a Medigap policy, you
will also need to enroll in a stand-alone prescription drug plan.

After you have decided on the type of coverage you want, you can enroll by telephone. The toll-
free numbers of the Advantage plans and the lowest-cost stand-alone drug plans are shown on
pages 2-4 of the evaluation. And the toll-free numbers for the insurance companies that sell
Medigap policies in Brevard County are listed in Attachment B.

If you decide to purchase a Medigap policy, we recommend that you call at least three
insurance companies and buy your policy from a large company that has relatively low
premiums (a government study indicated that large companies tend to have slightly smaller
annual Medigap premium increases). Attachment B shows each insurance company’s Medigap
premiums for a 65-year-old resident of Brevard county.

Your medical providers

Dr. Adams and Dr. Bennett both accept Medicare assignment, as indicated in Attachment A-1.
Dr. Cunningham and Duncan may accept assignment (you can verify whether they do with their
offices). If a doctor accepts Medicare but does not accept assignment, he or she can charge up
to 15% more than Medicare’s approved rates. Medigap Plan F covers this added charge but
Plan L does not. With Advantage plans, network providers accept the plan’s contracted rates.