Question from Gina: I’m a retired teacher and have a HOP Medical Plan. All my friends have Advantage Plans with much lower premiums that come with gym memberships, dental, and other things I don’t get. Should I consider moving to a plan like they have?

Answer: If you get the $100/month premium assistance, you absolutely should not consider moving to an Advantage Plan like your friends have! Let me be clear. Do not leave your HOP Medical Plan under any circumstance. 

You may not get all the “free stuff,” but let me tell you what your friends on HMOs and PPOs don’t get. They don’t get the freedom to go to any doctor or hospital in the country. They don’t get services such as MRIs, CT scans, surgeries, and others immediately upon doctors' orders like you do. Instead, they have to wait for authorization from their insurance company. And they don’t get the guarantee that they will never receive thousands of dollars in bills. 

It’s my opinion that the HOP medical plan for those who get the $100 premiums assistance is the best value in all of Medicare. You don’t want to give that up and risk never being able to get it back! 

Retired Pennsylvania Public School employees are the only people who need to be cautious

Anyone who is receiving Medicare coverage from a company they retired from also needs to be careful about opting out, even if the plan is more expensive. Generally, retiree coverage, especially Advantage Plans, offer much lower co-pays and Maximum Out of Pocket (MOOP) along with better prescription drug coverage. I just had a retired state employee inquire if he should leave his coverage. Upon review, I found that his wife would pay as much as $1,600 more for drugs moving to another Advantage Plan or Supplement with Stand-Alone Part D coverage. He also had $0 co-pays for services that would have cost him hundreds or even thousands on HMOs or PPOs that are available to the public.

Any agent who is quick to talk you into dropping your retiree coverage without a thorough evaluation has one thing in mind, making a commission. We take the exact opposite approach here at The Health Insurance Store. We’re extremely careful and don’t often advise people to leave their retiree plans, especially when doing so means they can never opt back in! 

That doesn’t mean 100% of people on retiree Medicare Plans are always best to stay with that coverage. There are times when these plans can be extremely overpriced and non-competitive. But opting out can be permanent. And with so much up in the air when it comes to future Advantage Plans premiums, benefits, doctor and hospital networks possibly shrinking and more, caution is necessary. 

Retirees and employees need to check their premiums and benefit changes for 2026. 

If you are on retiree or employer coverage, make sure you look at what changes will be made to your plan for 2026. Don't assume benefits, or your monthly or bi-weekly costs (for employer coverage) will be the same. Employer coverage costs are going through the roof, and some of that expense may be passed to you in the form of higher deductibles and premium deductions from your paycheck or pension.

We’re happy to evaluate your retiree or employer coverage, compare it to Supplements and Advantage Plans available on the open market, make sure you understand the ramifications of opting out and advise you on what choice is best. We never charge for this service or any consultation. 

If you have questions, feel free to call our office, 724-603-3403, or email me personally, Aaron@GetYourBestPlan.com.