Page 2 - Cover Letter and Mediicae Evaluation for Mr. Bruno V. Manno

All your physicians are listed in Medicare’s provider directory, as shown in Appendix A, and all
of them accept Medicare-approved rates. Your dentist, Dr. Irvin, is not listed in the directory,
but dentists seldom are because Medicare does not cover dental care.

Your ophthalmologists both accept Medicare, and you will have excellent coverage for diseases
of the eye – glaucoma, cataracts, etc. But Medicare does not cover routine vision care, and
those services won’t be covered when you see your ophthalmologists.

No Advantage plans that will meet your needs

As noted, there aren’t any Advantage plans that will meet your needs. There are only 16
Advantage plans in Montgomery County (the national per-county average next year is 27 plans
per county). Four of the plans are sponsored by Kaiser Permanente, which would require you to
use Kaiser physicians. Two of the plans are high-deductible Medicare Savings Accounts plans.

Also, two of the plans (including one of the Kaiser plans) do not include drug coverage, and you
are not eligible to enroll in either of these. And only three of the plans have annual costs for
your drugs that are less than $1,000 – whereas your lowest-cost stand-alone drug plan option
will cost $253 for the year. There’s only one Advantage PPO plan in the county, and its annual
costs for your drugs are more than $4,600. Appendix C is a list of the 16 Medicare Advantage
plans in Montgomery County, ranked by their estimated annual costs for the Rx drugs you take.

Guaranteed issue protection for Medigap policy

Because you are involuntarily losing your employer-sponsored supplemental coverage, you will
have a guaranteed right to get a Medigap policy without disclosing pre-existing conditions or
answering health related questions (your premiums will be adjusted for your age, though).

This is a valuable one-time right, and while there are other situations that have guaranteed
issue protections, they are not available except in unusual cases. Attached to this letter is
Medicare’s explanation of your guaranteed issue right. It is limited to people who currently
have original Medicare, which means that Medicare pays first and then the supplemental policy
pays the balance (up to policy limits) – that is the way your current supplemental indemnity
policy works.

When you acquire a Medigap policy, the insurance company will ask for documentation from
your employer plan that you are involuntarily losing your supplemental coverage.

Understanding how Medigap policies work

Medigap policies are similar in many ways to your current indemnity supplemental plan,
especially in the flexibility you have in choosing providers. There are no networks, and you will
be covered when you see any provider who accepts Medicare (as some 99% of doctors and

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