Ingrid was leaving her employer's health plan and met with us to shop for Medicare alternatives. She was hoping to save some money. Her plan at work had the coverage she needed, but it had a terrible $6,500 annual medical deductible. "I want to find something more affordable, but I want to keep my doctors and my preferred pharmacy," she told us firmly.
After educating her on the different Medicare plan options and benefits, she decided on a Medicare Advantage plan. We reviewed all 91 plans available in her area and narrowed her choices to those with her doctors. Then we narrowed her choices based on the plans that had her pharmacy. That left her with two options.
The Plan Picked Her
After reconfirming that her doctors were indeed on those two plans, we compared the prescription copays. She would pay $2,500 on one plan, while the other plan had her copays to just $1,200! "Why the big difference?" She wanted to know.
We explained that while both plans covered her prescriptions, each company categorized each drug differently. Medicine might be classified as a Tier 1 drug on one plan, but on another plan, it might be a Tier 2 or 3. The higher the Tier, the higher the copay in most cases.
After all that… the plan actually picked her. The plan had her doctors in the network, it had the hospital and pharmacy she wanted to use, and it had the most appropriate copays for her medications. This particular plan also included services not covered by Medicare that she was interested in accessing. Best of all, no medical or drug deductibles! She would save money by paying a low $185 monthly premium for Medicare Part B and no premium for the Advantage plan! She would still be responsible for any medical service copays if there was a copay. Her primary care doctor visits were free, labs were free, vision and hearing exam was free, gym membership was free, and the plan even had free transportation!
She was relieved that after only a one-hour visit reviewing her options, we had performed the research to help her select the exact one that met all her needs and requirements! "This would have taken me weeks of research and hours of stress trying to do this!" she exclaimed.
Not sure which Medicare plan is the right one for you? How would you like a Certified Medicare Planner® to perform all the research for you for free? Call us! We can help! (Pssst! By the way... tell your friends to call us too!)
By American Retirement Advisors
American Retirement Advisors helps retirees and pre-retirees navigate Medicare, estate planning, and retirement income — so you can enjoy the retirement you've earned.
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Easy Eddie's Take
This story about Ingrid shows exactly why Medicare Advantage plan shopping can be so overwhelming. Most people are surprised when they learn that all 91 Medicare Advantage plans available in their area could have completely different drug formularies and provider networks. The Centers for Medicare & Medicaid Services allows each plan to create their own tier structure, which is why Ingrid's medications cost $2,500 on one plan but only $1,200 on another.
Here's what makes this even trickier: Medicare Open Enrollment runs from October 15th through December 7th each year, and during those eight weeks, you need to check that your doctors are still in network, your pharmacy is still covered, and your prescriptions haven't moved to different tiers. A lot of people ask me, "Can I keep my same Medicare Advantage plan every year?" The answer is yes, but the plan details often change, so it's worth reviewing annually.
The good news is that Medicare Advantage plans in 2026 continue to offer those extra benefits like gym memberships, transportation, and even some dental and vision coverage that Original Medicare doesn't include. A little research during open enrollment can save you thousands of dollars, just like it did for Ingrid.