Page 3 - Cover Letter and evaluation for Michael Hartzmark

also cover it, up to policy limits. Because Medicare is more lenient in approving certain
treatments than are insurance companies, Medigap policyholders may in some cases be
covered for treatments that people in Advantage plans may not be (the Advantage plan could
say that the treatment is not medically necessary). For that reason, people with pre-existing
conditions will usually get Medigap policies.

Most Medigap policies do not cover routine vision/dental care or hearing aids, none of which
are covered by Medicare. But it is possible that there are “innovative benefit” Medigap plans in
Florida that include limited dental/vision benefits. And with the exceptions of Plan K and Plan L,
Medigap policies do not have out-of-pocket limits, although that is rarely an issue because
Medicare’s underlying catastrophic protection is excellent.

Two of the plans compared in your evaluation -- Plan G and Plan N – also include some
coverage for foreign travel medical emergencies. This coverage includes a $250 deductible for
each event, after which the Medigap plan covers 80% of the balance, with a $50,000 lifetime
limit.

During the first six months that people have Part B, insurance companies are required to sell
them Medigap policies without asking health-related questions. After this six-month
guaranteed issue period is over, insurers can ask applicants about pre-existing conditions and
can charge higher premiums or deny coverage (that’s also true when people later try to
upgrade to a more comprehensive plan or to switch their Medigap policy to another company
with lower premiums).

Medigap premiums

You will need to call the insurance companies that sell Medigap policies to get current quotes.
The companies’ phone numbers are included in the list of Medigap premiums from the Florida
Office of Insurance Regulation in Appendix B1. This list of companies is sorted by their
premiums for Plan G.

Appendices B2 through B4 are premium comparisons from CSG Actuarial, a firm that provides
quotes for insurance agents. These premiums should be current, but in a few cases they may
not include the agents’ commissions (there is no way for me to know which ones these are).
CSG Actuarial’s premiums also show most companies’ financial ratings from AM Best and, for
the larger companies, Standard & Poor’s (S&P).

While it’s important to get your policy from a company that has low premiums, you might also
take into account a company’s size and its financial strength. A large government study several
years ago found that larger insurers have slightly lower annual premium increases. So, the goal
is to choose a lower-premium insurer that is financially strong.

As mentioned, the benefit designs of the eight Medigap plans available to you are on pages 6-7
of the evaluation. Here are summaries of the three plans compared in your evaluation:

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