Choosing a Medicare Advantage plan

How does a person pick a Medicare Advantage plan?  Is the hospital network the most important factor?  Is having the biggest network of doctors important?  Is the plan with the lowest co-pays for doctor visits and hospital stays the top choice?  Are drug co-pays for expensive brand drugs the deciding factor?

The answer to all the questions above is “yes”….. depending on the person making the decision.


Some people want to go to University Medical Center (UMC in Tucson) if they need complicated surgery – but only two Medicare Advantage plans in Tucson are contracted with UMC. So this would narrow down a person’s choices for a Medicare Advantage plan pretty quickly.


Some people have four or five doctors and they want to keep seeing them when they get on Medicare. If they want an Advantage plan, their insurance agent will need to make sure all their doctors are contracted with the plan he recommends.  In Tucson there are two or three Advantage plans that have very large networks that might include all five of a person’s doctors.  So this will narrow down a persons Medicare Advantage plan options.


If a person is turning 65 and hasn’t been to a doctor in a long time, she might be more open to a small-network Advantage plan. Small-network plans will have lower co-pays for doctor visits, hospital stays, outpatient surgery, and skilled nursing facility charges.

If cost is the most important factor for someone turning 65 and considering Medicare Advantage, they will choose an Advantage plan that has a small network.


Drug co-pays can vary from Advantage plan to Advantage plan. One brand drug might have a $45 co-pay on one plan, and that same drug might have a $95 co-pay on another plan.  Even co-pays for generics can be very different from plan to plan. One Advantage plan charges $15 for Hydrocodone while another plan charges $40 for the same generic drug.

Insulin is another drug with very different co-pays from plan to plan. One plan has no charge for insulin, except for the new insulin pens that are easier for people to use. These insulin pens have a $35 co-pay, but the lancets have no co-pay.  Most Advantage plans charge a $45 co-pay for all insulin, and one plan charges $35 for the insulin pen lancets in addition to the $45 pen co-pay.


I can’t name names here because I am an insurance broker and I cannot be seen as promoting one Advantage plan over another.  Actually, there isn’t one plan I would say is “the best” – which is something Medicare strictly forbids agents from saying.  Some plans have big networks. Some plans have a smaller network and lower co-pays.

I have talked to people who are diabetic and suggested they enroll in the plan that has no charge for insulin. But a number of people would not consider this plan even if they could save a lot of money on their medical and drug bills. Their decision came down to keeping their three or four doctors, or their concern about being in a Medicare Advantage plan with a small network of hospitals and doctors.

Picking a Medicare Advantage plan is easy for a healthy person. For folks with a long list of doctors and drugs, selecting a Medicare Advantage plan can be quite complicated.

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