Page 2 - Cover Letter & Evaluation for Isaac Kapon

But after that initial six-month period has passed, insurance companies will ask questions about
an applicant’s health status and may charge higher premiums or deny coverage to someone
who has a serious pre-existing condition or an upcoming surgery.

In many cases it is not a problem to acquire a Medigap policy at some later point. But if you are
planning to have joint replacements in the future and you decide to wait to purchase a Medigap
policy, one of the questions you may be asked is whether any doctors have recommended that
you have surgeries that you haven’t yet scheduled. If they ask this question, there’s also a good
chance that they will decline to cover you – at least until those surgeries are completed.

Therefore it makes sense to purchase a Medigap policy and enroll in a Part D stand-alone plan
when you first become eligible for Medicare in November. Later after your surgeries have been
completed, you can (if you wish) switch to a less expensive Advantage plan during the annual
open-enrollment period. Advantage plans cannot ask you health-related questions or charge
you more because of pre-existing conditions (the only exception is that they can deny coverage
to people who have end-stage renal disease).

Your medical providers

All four of your physicians accept Medicare, as shown in Attachment A1 (doctors who do not
accept Medicare assignment can charge up to 15% more than Medicare-approved rates). But it
appears that none of the four Advantage PPO plans in Clark County have all your physicians in
their networks, as shown in Attachments A2 and A3.

Even though your best choice is likely to get a Medigap policy and a Part D stand-alone plan, I
decided to include two Advantage PPO plans in the evaluation. But none of the PPO plans lists
more than two of your physicians in its network, and so these plans could turn out to be costly.
As you know, in a PPO you will still be covered when you go outside the network, but in these
two plans you pay 40% of the cost for most services (except for preventive services).

The Advantage plan network directories that we rely on are sometimes out of date. If you are
interested in one of these Advantage PPO plans, you could call your doctors’ offices to verify
whether they are in the plans’ networks.

Here are brief descriptions of the four options compared in your evaluation:

The two Medigap plans in your evaluation

Perhaps Medigap policies’ best feature is that they do not have networks. That means that you
do not need referrals to see specialists and that you will be covered when you go to any doctor
who accepts Medicare -- you can see virtually any doctor or go to any clinic or hospital in the
country and you will be covered.

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