Thursday, 29 April 2021 12:49

Getting a Better Deal: Drug Pricing and Seniors

By Blue Chip Financial | News
Getting a Better Deal: Drug Pricing and Seniors

In our business as health insurance brokers, we often come across people newly enrolling in Medicare who request to be placed on the same Advantage plan as a friend or neighbor. When this happens, we often must slow the person down and remind them that, unlike group or employer health insurance, Medicare Advantage plans are individual. This means a plan that may work well for another person’s health circumstances may not be best suited for yours.

This principle is perhaps best illustrated when comparing drug pricing between Advantage plans. The Center for Medicare and Medicaid Services (CMS), the federal agency that oversees the Medicare program, classifies prescription drugs into five tiers based on their price, with the least expensive prescriptions generally falling into tier 1 and the most expensive into tier 5.

At this point, many people exclaim: “See, Medicare has done all the hard work for me! All I have to do is know what tiers my prescriptions are in and I’m all set!” However, this response does not consider the fact that CMS gives individual Medicare Advantage plans broad discretion over the tier they assign to a drug and any deductibles and copays they impose. In other words, a tier 3 drug on one Advantage plan could be classified as a tier 4 on another, with vastly higher deductibles and copays.

As an example, we recently did a drug comparison for a gentleman using two similar zero-premium Advantage plans available here in the Capital District. For the same prescriptions, we estimated that one plan would charge $164 per year while the other would charge $1,240, a projected annual difference of $1,076. Again, these projections were for the same prescriptions for the same person. 

So, how do you get a better deal when it comes to prescription drug prices? In our view, nothing can take the place of working with a knowledgeable health insurance broker who can walk you through all your options. To see if we can help you save money on your prescriptions, please contact Blue Chip in Saratoga at 518-584-8057 or visit our website at    

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