Page 2 - Cover Letter and Medicare Evaluation for Mrs. Jane Miller

Your physicians’ network affiliations

As shown in Appendix A1, all your physicians appear to accept Medicare-approved rates. Dr.
Maria Chen is not listed individually, but the University of Penn Medical Group is, and if she is
still with that group, she will also accept Medicare. Still, before you get a Medigap policy you
should verify with her office that she accepts Medicare patients.

Appendices A2 and A3 indicate that your physicians – with the exception of Dr. Chen in the
Aetna Medicare Value PPO Plan – are in the networks of the Advantage plans in your
evaluation. The plans’ online directories are sometimes out of date, however, and before
enrolling in an Advantage plan you should verify that your physicians are in its network. You
might still choose to enroll in an Advantage PPO plan even though one or two of your
physicians are not in its network, but at least you’ll know that you’ll pay higher out-of-network
costs when you see them.

As a side note, it appears that you will be covered when you see Dr. DeGroot in all of the plans
compared in the evaluation. But Medicare covers relatively few chiropractic services, and so
even though you will have some coverage when you see him, a particular treatment that you
need may not be covered by Medicare.

Medigap policies

The first two options in your evaluation are Medigap policies – Plan G and Plan N. Their
premiums are in Appendix B2 (for Plan G) and Appendix B3 (for Plan N). Appendix B1 is a list of
the phone numbers of the insurance companies licensed to sell Medigap policies in Delaware.

It might help to review some features that all Medigap policies share. The most important thing
to be aware of is that during the first six months that you have Part B, you can get a Medigap
policy without having to answer health-related questions. But after that six-month period
guaranteed-issue period is past, in Delaware and most other states you will likely have to
answer questions about your health before you can get a Medigap policy or – if you already
have one – to upgrade from a less comprehensive Medigap plan to a more comprehensive one,
e.g., from Plan N to Plan G. Individuals with serious pre-existing conditions may not be able to
get a Medigap policy after the initial guaranteed-issue period.

Perhaps the most desirable attribute of Medigap policies is the flexibility they offer. There are
no networks, and you do not need referrals to see specialists. You will be covered when you see
any provider who accepts Medicare (as more than 98% of doctors and public hospitals do).

In most cases Medigap policies do not cover routine dental and vision care or hearing aids
(neither does Medicare). Some states authorize the sale of “innovative” Medigap plans that
include dental and vision benefits, but I was unable to find any of these policies in Delaware.

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