Page 3 - Diane Peasley's Medicare Evaluation

more. Plan F covers this additional 15% surcharge, but Plan L does not. In most cases the extra
surcharge of up to 15% winds up being a few dollars, but in the case of an expensive treatment
it could be more.

It’s not clear whether Dr. Chen accepts assignment, although it’s not unusual for a doctor not to
be listed on the Medicare web site. If you decide to get Plan L, you may want to check with his
office to verify that he accepts assignment.

The two Medicare Advantage plan in your evaluation

There are a large number of Advantage plans in your area, and the two plans that are included
in your evaluation were selected based on the following criteria – 1) they are PPO plans; 2) they
are among the lower-cost plans for the Rx drugs that you take 3) most or all of your doctors are
listed in their networks, and 4) their health plan premiums are fairly low for PPO’s in your area.

Both plans also have above-average 4-star quality ratings from Medicare. These quality ratings
can be important measures of how well plans are likely to perform (roughly 75% of all
Advantage plan enrollees are in plans rated four stars or higher). There is detailed information
about each of these plans on pages 2-4 of your evaluation and in the appendices. Here is a brief
description of each of them.

1) The Aetna Medicare Select PPO Plan. This plan has a large network of more than 18,000
providers, with all your physicians listed in its network (as shown in Appendix A2).
Before enrolling in an Advantage plan, though, we recommend that you verify with your
doctors’ offices that they accept this plan, since the online provider directories are
sometimes out of date.

This plan’s out-of-pocket limits for health care (not including Rx drug costs) are lower
than those in many other Advantage PPO plans -- $5,900 if you see only network
providers and $8,500 for combined in and out-of-network services. When you do see an
out-of-network provider, you will pay 40% of the cost. And this plan’s monthly premium
for health care is $59.50.

Medicare requires Advantage plans to have separate premiums for health care and Rx
drug coverage, although people enrolled in Advantage plans pay only one premium a
month – a combined health care/Rx drug premium.

This plan’s estimated annual costs for your prescription drugs are $12,083 in 2018– that
includes the plan’s $26.50 monthly Rx drug premiums and co-payments for all your
drugs. This plan does not have an Rx deductible. These costs assume you will get
monthly refills at Walmart. Even though you currently get mail-order refills, in each of
your drug plan choices in the evaluation, you will save money by getting monthly refills
at a retail pharmacy, although the lowest-cost pharmacy may be different from one plan
to another. In this plan, it costs $1,100+ more for mail-order refills.

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