Page 5 - Cover Letter and Evaluation for Craig Callan

states and you can see virtually any doctor in Florida and be covered. Once you are settled in
Florida, you can switch to an Advantage plan during annual open enrollment.

The two Medicare Advantage plans in your evaluation

As already mentioned, there are only two Advantage PPO plans in Montgomery County, both
sponsored by Johns Hopkins. These two plans are similar in many respects – they have the
same provider networks, the same hospitalization costs, the same out-of-pocket limits, etc.

The Johns Hopkins Advantage MD Plus PPO Plan’s medical premiums are $310 a year higher
than those of the Johns Hopkins Advantage MD PPO Plan. In exchange for the higher premiums,
the Plus plan has better benefits for routine dental and vision care and a $5 co-payment for in-
network primary care doctors’ office visits vs. a $10 co-payment in the Johns Hopkins
Advantage MD PPO Plan.

In either of these plans, you are accepting more risk than you’ll have with a Medigap policy, but
you will also have lower premiums. These plans have a $6,700 out-of-pocket limit for network
services and a $10,000 OOP limit for in-network and out-of-network services combined -- limits
that do not include plan premiums and Rx drug costs.

The Freestyle Libre Glucose Monitoring System

Medicare covers the Freestyle Libre system as durable medical equipment (DME) and pays 80%
of the cost. Medigap Plan N covers the other 20% and the High-Deductible version of Plan F
covers it only after the plan’s $2,300 deductible has been paid.

Both Advantage plans in your evaluation cover 80% of approved DME costs, as shown in the
benefit details of Appendices B2 and B3. Advantage plans are required to cover the same
services as traditional Medicare, but they do not necessarily have to cover every product that
Medicare covers. It is possible that some Advantage plans do not cover the Freestyle Libre
system, taking the position that other glucose-monitoring systems are equally effective.

Before you enroll in an Advantage plan, you might try to verify whether the Freestyle Libre
system will be covered and at what cost. It probably will be, but it doesn’t hurt to ask before
enrolling in a plan. I did read on a Medicare discussion board that one patient said that her
Aetna Medicare Advantage plan had approved this system. In an Advantage plan, you should
use one of the plan’s approved (network) DME suppliers.

Rx Drug Plan Coverage

The first page of Appendix C1 lists your Rx drugs, dosages and monthly quantities as they were
entered in the Medicare web site’s Plan Finder, which uses this information to find the lowest-
cost plans (either Advantage or stand-alone) for a set of drugs. Aspirin and other over-the-
counter drugs are not covered by Part D, and so it is not listed.

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