All Medicare Advantage Plans Not Created Equal

I was recently doing some research for a new client turning 65 to determine what Medicare Advantage Plan(s) would be a good choice for him. As an independent agent, I do not “push” one plan over another. I look at the client’s doctors, what hospitals or labs he/she prefers to use and of course his/her current drug list. Why? Because not all Medicare Advantage Plans are created equal. And now that it’s the Medicare Open Enrollment time, October 15 till December 7, perhaps you should evaluate your current plan.

The government sets certain regulations for Medicare Advantage plans. As an Agent, I can not cold call potential clients to see if they might benefit from my services. That contact must be initiated by them. In fact, the only way I can market my services to potential clients is by snail mail. And we all know what happens to the reams of paperwork we get in the mail!

But seriously, things such as the limits on the maximum out of pocket (MOOP) a plan can charge. Currently that amount is set at $6700. Did you know, that in 2018 one Medicare Advantage plan in Tucson reduced their potential MOOP to $2800? But in three other well-known plans in Tucson, the MOOP is set at $3400, $3050 and $4900. Might make a difference to someone who had to use their insurance frequently.

But here’s where the BIG differences can occur. Prescription drug costs.

In Medicare Advantage plans, your Part D coverage is usually included. Yes, you still pay for your prescriptions, but let’s take a look at my recent client’s potential costs. I will call him Joe Average.

Mr. Average is currently on 5 daily medications. Depending on the plans from which he can chose, his drugs may be covered differently. For instance, one medication he is on, Livalo, is considered a preferred brand drug on one plan, a non-preferred brand on another plan, and not even included on the third plans formulary. His cost difference for this one drug respectively on the three plans is $45 and $100 and $310 per month based on the plan in which he might enroll. Below is a chart illustrating his total drug costs for all 5 medications based on 6 plans currently available in Tucson. These numbers come directly from for 2018.

This monthly difference may be just enough to convince Mr. Average to enroll in one plan over another. That is where it helps to have an Agent do your research for you prior to making any decisions on what plan to enroll in. Oh, and by the way, you can buy that expensive drug overseas for only $16.20 a month. Who knew health insurance could be so complicated?

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