Page 5 - Cover Letter & Evaluation for Isaac Kapon

expect to use relatively few medical services. It has a network of more than 3,000
providers and a 3.5-star quality rating from Medicare (the highest possible rating is 5
stars).

This plan also has substantial risks -- a high deductible of $1,500, a $6,700 out-of-pocket
limit for network services, and a $10,000 out-of-pocket limit for combined in- and out-
of-network services. In the cost comparisons on page 3, I’ve included the $1,500
deductible in your minimum costs, although it’s unlikely you would spend that much.

Perhaps this plan’s largest downside is that Drs. Alfreda and Henry are not listed in its
network directory. And when you go out of network, you will pay 40% of the cost. For
the remainder of 2017, this plan’s premiums are $47 a month for medical coverage.

2) Aetna Medicare Choice PPO Plan. This plan has an above-average quality rating of four
stars and a $750 medical deductible, which is one-half the Humana Choice PPO Plan’s
medical deductible. Its out-of-pocket limits are the same as those of the Humana plan --
$6,700 for network services and $10,000 for network and non-network services.

Perhaps this plan’s two biggest drawbacks are 1) its $46 monthly premium for Rx drug
coverage and 2) the fact that Drs. Alfreda and Thomas are not listed as network
providers. In this plan, you will also pay 40% for out-of-network services unless they are
recommended preventive services. For the remainder of 2017, this plan’s medical
premium is $15.60 a month and its Rx drug premium is $19.40 a month.

Rx Drug Coverage

Congratulations on belonging to the 9% of Medicare beneficiaries who do not take any
prescription drugs. The lowest-premium Part D stand-alone plan is the Humana-Walmart Rx
Plan, which will have a monthly premium of $20.40 in 2018. It is also the lowest-premium
stand-alone drug plan in 2017, with a $17 monthly premium. CVS and Walgreens are in this
plan’s network, although they are not preferred pharmacies. If you need a short-term
prescription filled, in this plan you will typically get the lowest prices at a Walmart Pharmacy.

Another good plan is the Express Scripts Medicare Saver plan, whose premiums are slightly
higher at $22.60 a month. I did not include the Symphonix Rx Value prescription drug plan as an
option, even though its monthly premium is the same as the Humana-Walmart’s plan, because
last year it had a below-average quality rating of 2.5 stars (plans that have below-average
ratings for three straight years are placed on probation by Medicare).

Services Not Covered by Medicare

While Medicare covers most medical services, there are some that it does not cover – routine
dental and vision care as well as hearing aids. Medicare does, however, cover treatments for
diseases of the eye. Neither does Medicare cover the cost of medical services outside the

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