Troy Medicare

About Troy Medicare

Troy Medicare operates as a health insurance company with a focus on Medicare Advantage plans, specifically targeting underserved communities. The company was founded in 2018 by Flaviu Simihaian, Amina Abubakar, Joe Moose, and Josh Young, a team of software engineers and pharmacists. Their establishment of the company stemmed from observing the treatment of seniors, physicians, and pharmacies by large insurance corporations.

The firm's business model is centered on providing Medicare Advantage plans, which are an alternative to traditional Medicare run by private insurers under contract with the federal government. Troy Medicare receives a fixed payment from the government for each member and, in return, covers the full cost of their care. The company distinguishes itself by partnering with local, independent pharmacies, paying them directly to offer enhanced care management services. This approach leverages the trusted relationship between pharmacists and patients to improve health outcomes. Revenue is generated through these government payments, with an estimated annual revenue of $15.6M.

Troy Medicare offers simplified health plan options, including a $0 premium, $0 deductible plan with $0 copays for primary care and specialist visits. A key feature of their service is the use of a transparent drug pricing model based on the National Average Drug Acquisition Cost (NADAC), which allows patients to know the exact cost of medications beforehand. Their offerings also include benefits for dental, vision, and hearing. For dual-eligible beneficiaries (those with both Medicare and Medicaid), plans can include additional benefits for over-the-counter items, food, and utilities. The company utilizes its proprietary technology platform, Troy.AI, to provide chronic disease management solutions and help members find the lowest prices on medications.