Page 5 - Cover Letter and Evaluation for Paul Stelter

With an AARP policy, then, your premiums may go up more quickly until you turn 77. After that,
they may increase more slowly than those of many other insurers because the AARP premiums
are based on a modified community rating that tends to favor older retirees.

The two Medicare Advantage plans in your evaluation

Medicare Advantage plans are managed-care plans – HMO’s and PPO’s, for the most part.
There are 49 Advantage plans in Will County, although a few of these plans do not include Rx
drug coverage. Because you do not have creditable drug coverage from another source, you
cannot enroll in an Advantage plan that does not include drug coverage.

In Appendix C1, the Advantage plans are ranked by their costs for the Rx drugs you take. In both
plans compared in your evaluation, the annual costs for your drugs are negligible -- $0 in one
plan and $3 in the other – if you continue to get mail-order refills. That includes co-payments,
deductible, and premiums. Also, both plans have zero premiums and zero deductibles for
health and Rx drug coverage and zero co-payments for primary care doctors’ office visits.

Your evaluation compares an Advantage PPO Plan and an Advantage HMO Plan. Both plans
have above-average four-star quality ratings from Medicare as well as some dental, vision and
hearing benefits.

Here are brief descriptions of these plans, whose benefit summaries are in the appendices.

• The Aetna Medicare Value PPO Plan. This plan is also compared in your wife’s
evaluation. For a PPO, this plan has a fairly low out-of-pocket limit of $3,950 for
network medical services but a much higher $8,250 limit for in- and out-of-
network services combined. And its out-of-network costs for many medical
services are 50% of cost. For people who enroll in this plan, it’s important that
they remain in network for almost all their medical services. This plan’s benefit
summary is in Appendix C2

• The Humana Gold Plus HMO Plan. This plan’s out-of-pocket limit a low $2,650
and its co-payments for medical services are lower than in many plans. As you
know, in an HMO unless it’s an emergency you are covered only when you see
network providers. And you will likely need referrals from your primary care
physician before you can see a specialist. This plan’s benefit summary is in
Appendix C3.

Rx Drug Plan Coverage

As mentioned, your Rx drug costs will be close to zero in either of the Advantage plans.

In the two stand-alone drug plans shown on page 4 of the evaluation, your annual drug costs
are about $245, including premiums and co-payments and assuming you get mail-order refills.

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