Page 2 - Cover Letter and Evaluation for Barbara Lesswing

stand-alone plan – that’s compared to what you will pay if you remain in your current plan,
even after switching to mail-order refills.

How does the medical coverage of the two plans compare? In the Health Encompass 65 HMO
plan, there are no premiums for health coverage, saving you about $380 a year compared to
your present plan. Also, your current plan’s out-of-pocket limit of $6,700 is almost twice as high
as the $3,400 OOP limit in the Health Encompass 65 HMO plan.

Otherwise, the benefits of the two plans are generally similar. Both have the same co-payments
for doctors’ office visits and many other services, including the limited dental and vision
benefits that both plans offer. Co-payments for certain services, however, are lower in your
present plan, e.g., co-payments for hospital days 1-6 are $50 per day lower in your present
plan. Appendix B3 has a detailed comparison of the two plans’ costs and benefits.

Adding it all up, by changing your Advantage plan coverage and switching your Rx drug refill
schedule, you will be able to your total fixed (or minimum) costs by more than $1,000 next year
– that’s compared to staying in your present plan and continuing to get monthly refills.

Medigap policy

Included in the cost comparisons is a Medigap policy – Plan G. This is probably not a good
option for you, but at least you will have an idea of the tradeoffs involved. Virtually all of your
Medicare costs are covered in Plan G – the only exception being the Part B deductible ($183 in
2017). That means that once you’ve satisified the Part B deductible, you will have no further co-
payments or cost-sharing for the rest of the year. Also, Medigap policies do not have any
networks, and so you will be covered when you see any doctor who accepts Medicare.

People who have serious pre-existing conditions or need expensive treatments can come out
ahead financially in a comprehensive Medigap plan like Plan G. That’s because they will likely
have frequent and occasionally large co-payments in an Advantage plan.

As you may know, in New York state Medigap policies are community rated, so that 65-year-
olds and 95-year-olds pay the same premiums. For that reason, Medigap policies are overpriced
for younger retirees but can sometimes be bargains for older people who use many medical
services. Also, in New York Medigap policies are guaranteed issue, which means that insurers
cannot deny coverage or charge higher premiums to people with health concerns. That makes it
easy for people to switch to Medigap coverage.

Rx Drug Plan Coverage

You might check the list of your Rx drugs and dosages attached to this letter to verify that it’s
accurate. If any information there needs to be changed, it could affect the costs. The estimated
costs are total costs – premiums, deductible, and co-payments.

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