Page 2 - Evaluation for Dirk Huybrechts

One thing to be aware of in choosing a Medigap plan is that if you see a doctor who does not
accept Medicare assignment, he or she may charge up to 15% more than the Medicare-
approved rate. Plan F covers that additional charge, but Plans N and L do not.

As shown in Attachment A, Dr. Michael Reynard is listed on the Medicare web site as accepting
Medicare assignment and also as a network provider in the Aetna Medicare Choice PPO plan.
Dr. Ross, however, is not listed in either directory. It’s common for physicians who belong to
larger medical groups not to be listed in the provider directories (Dr. Ross is a member of the
Providence Health & Services Group, also shown in Attachment A). As a safeguard, you may
want to verify with his office that he accepts Medicare, and if you get either Plan N or Plan L,
that he accepts Medicare assignment.

Medigap policies do not cover prescription drugs, so if you purchase a Medigap policy you will
also need to enroll in a Part D stand-alone drug plan. Neither do Medigap policies cover routine
dental and vision care or hearing aids. Plans F and N do have some benefits for medical
emergencies while traveling outside the United States, which Medicare does not cover.

Here are summaries of the three Medigap plans compared in the evaluation:

1) Medigap Plan F. This is the most comprehensive of all 10 Medigap plans, covering all of
Medicare’s gaps. That means that you will have no cost-sharing (co-payments or
deductible) for Medicare-covered services. And if you see a doctor who does not accept
Medicare assignment, any excess charges levied by that doctor will also be covered. You
can likely buy a Plan F policy that has annual premiums in the $2,300 range (I’ve
assumed $2,330 in the evaluation). In this plan, your entire cost for Medicare-covered
services is in the premiums (Medigap premium + Part B premium) and thus is
predictable.

2) Medicare Plan N. This is a slightly less comprehensive plan but it still has excellent
coverage. Its annual premiums are in the $1,800+ range. Even though you will have
some cost-sharing in this plan, you will likely come out $200 or $300 ahead unless you
use numerous medical services or undergo expensive treatments.

3) Medicare Plan L. This is the least comprehensive of the three Medigap plans compared
in the evaluation but it could also save you the most money, assuming you use relatively
few medical services and do not have any expensive treatments. Its annual premiums
are about $600 less than those of Plan F. It also has a low $2,560 out-of-pocket (or OOP)
limit – it is one of only two Medigap plans with an OOP limit. But the OOP limit does not
include premiums and it applies only to the services that the plan covers. As an example,
the $183 Part B deductible is not covered by this plan and so any money you spend
toward the deductible will not apply to the OOP limit.

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