Page 4 - Cover Letter and Evaluation for Anne Ellzey

When a doctor accepts assignment, it means that he or she agrees to accept Medicare’s
approved rates. There are some physicians who accept Medicare but do not accept assignment,
in which case they can charge up to 15% more than Medicare’s approved rates. Medigap Plans
F and G cover this 15% surcharge, but Plans N and L do not.

Even though Dr. Warmann has opted out of Medicare, if she refers you to other providers
(specialists, labs, etc.) it’s possible that those services may be covered by Medicare. Some opt-
out providers have registered to refer patients to other providers for Medicare-covered
services. If she refers you to other providers, you might want to clarify this with her.

Rx Drug Plan Coverage

Please verify that the names, dosages, and monthly quantities of your Rx drugs are correct
(they are an attachment to this letter). As mentioned above, if you buy a Medigap policy you
will also need to enroll in a Part D stand-alone plan.

For 2018, the lowest-cost stand-alone plan for the Rx drugs that you take is the Aetna Medicare
Rx Saver Plan – it is the lowest-cost plan for mail-order refills as well as for monthly refills at a
local pharmacy. On your questionnaire you checked that you use both monthly and mail-order
refills (perhaps depending on the drug).

In the Aetna Medicare Rx Saver plan, the least expensive option is to get monthly refills at an
HEB pharmacy where your estimated 2018 costs are $4,217. If you get mail-order refills, your
estimated 2018 costs are $4,401, or almost $200 more than if you get refills at HEB. Costs
include premiums, deductible, and co-payments for your drugs.

2017 Costs

Because you will be enrolled as of December 1, you may also want to factor in the costs for the
month of December. Part D stand-alone plans often change their costs and benefits
substantially from one year to the next, partly because of formulary changes. That’s the case
here, where the Aetna Medicare Rx Saver plan is an expensive choice for the month of
December, primarily because of this plan’s $400 deductible.

Here are two suggestions about ways you may be able to save money, based not only on plan
you choose for the month of December but on how you use that plan.

1) Enroll now in the Aetna Medicare Rx Saver Plan but use it sparingly in December.
This is the simplest choice because it does not require you to change plans during
the month of December. In 2017 this plan has a below-average monthly premium of
$28.90, and that would be your only fixed cost. Partly because of this plan’s $400
annual deductible (which in this case is a $400 deductible for only one month of

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