Page 4 - Cover Letter and Evaluation for Gary Janke

1) Blue Advantage Garnet PPO Plan. This plan has zero premiums and zero deductibles for
both health and prescription drug coverage. Perhaps its biggest weaknesses are high
out-of-pocket limits -- $6,700 for medical services received in network and $10,000 for
in and out-of-network combined. Those limits are not unusual, however, for Advantage
PPO plans. Also, there are stiff penalties for going outside the network, where you will
pay 50% of the cost except in emergencies. This plan’s prescription drug coverage is
discussed below.

2) Blue Advantage Ruby PPO Plan. This plan does have premiums -- $560 a year for health
coverage plus another $712 for prescription drug coverage. On page 3 of your
evaluation, the drug premiums are included in this plan’s $1,480 annual drug costs.

The higher premiums are used to reduce your out-of-pocket risk. This plan, for instance,
has a $4,800 out-of-pocket limit for medical services compared to $6,700 for the Garnet
PPO plan. And this plan has somewhat lower costs for a hospital stay. But the higher
premiums do not add any value for Rx drug coverage.

Rx Drug Plan Coverage

Please review the prescription drug list attached to this letter – this list was used to estimate
your 2019 costs. The dosages shown are for monthly refills that’s the best way to get accurate
pricing. The plans are sorted, however, by their mail-order costs, assuming that is what you will
choose. You may decide to use a combination of both refill schedules – 90 days for your
maintenance drugs and 30 days for your as-needed drugs.

If you purchase a Medigap policy you will also need to enroll in a Part D stand-alone plan,
where the lowest-cost plan for your drugs is the Wellcare Value Script Prescription Drug Plan. If
you get mail-order refills, this plan’s annual costs in 2019 are an estimated $1,400. That
estimate includes premiums, deductible, and co-payments. Walgreens is not a preferred
pharmacy in this plan, and if you need to get refills at a local pharmacy you will likely get lower
prices at a CVS pharmacy.

One possible negative for this plan is that in 2018 it has a quality rating of only 2.5 stars, which
is below average (plans that are below average for three straight years are placed on probation
by Medicare). The 2019 plan ratings will be available in the next week or two, I imagine, and
they may be higher. If you get a Medigap policy and wanted to avoid Wellcare, the next lowest-
cost Part D stand-alone that is not sponsored by Wellcare is the Humana Preferred Rx Plan,
whose annual mail-order costs next year are an estimated $1,972. Let me know if you want
more info on this plan, including its preferred pharmacy list.

If you enroll in an Advantage plan, your Part D benefits are included in the plan. The
Blue Advantage Garnet PPO Plan’s mail-order costs for your drugs in 2019 is $903, while the
Blue Advantage Ruby PPO Plan’s mail-order costs are $1,480 (primarily because of the plan’s Rx

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