Mr. Romero is 64

Mr. Romero is 64, retiring soon, and considering enrollment in his employer-sponsored retiree group health plan that includes drug coverage with nominal copays. He heard about a neighbor’s MA-PD plan that you represent and because he takes numerous prescription drugs, he is considering signing up for it. What should you tell him?

a. When possible, it is always the best option to have both the employer’s plan and the MA-PD, so he would have no out-of-pocket expenses.

b. He should compare the benefits in his employer-sponsored retiree group health plan with the benefits in his neighbor’s MA-PD plan to determine which one will provide sufficient coverage for his prescription needs.

c. Generally, employers prefer retirees to enroll in a stand-alone PDP, so he should consider that instead of the MA-PD.

d. Generally, employers prefer retirees to have both the retiree group plan and the MA-PD plan to fill in the gaps, but he would be better off with just the MA-PD plan.

The best option would be:

It’s important to remember that health and drug coverage needs can be quite individual, so comparing the specific benefits of each plan is key. This should include a comparison of which medications are covered under each plan, the cost-sharing details for his medications, and any other services he may need.

While having multiple plans might provide additional coverage, it could also lead to increased costs and potential coordination of benefits issues. Therefore, it’s always advisable to compare and understand the specifics of each plan before making a decision. Also, keep in mind that once you enroll in a Medicare Advantage plan, you can’t be sold a Medigap policy.

He should compare the benefits in his employer-sponsored retiree group health plan with the benefits in his neighbor’s MA-PD plan to determine which one will provide sufficient coverage for his prescription needs.

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