What matters most when you are choosing a Medicare Advantage plan

Medicare Advantage plans are sold by insurance companies, not by Medicare itself, and each plan sets its own costs, doctors, and coverage rules. You cannot compare them the way you compare Original Medicare — you have to look at the specific plan's network, copays, and what drugs it covers. The plan that works for your neighbor may cost you hundreds more or leave out your doctor.

Start by listing three things: the doctors and hospitals you use now, the prescription drugs you take regularly, and how much you can afford to pay each month. Then check whether each plan you are considering keeps those doctors in its network and covers those drugs at a price you can manage. A plan with a low monthly premium can become expensive fast if your doctor is out-of-network or your drug is not covered.

Key Takeaways

  • Every Medicare Advantage plan has a different network of doctors, hospitals, and pharmacies, so you must check whether your current providers are included before you enroll.
  • Plans vary widely in copays, deductibles, and out-of-pocket limits, and the cheapest monthly premium often means higher costs when you actually use care.
  • Medicare.gov's Plan Finder tool lets you enter your doctors and drugs and see which plans cover them and at what cost — this is the fastest way to narrow your choices.
  • You can change plans once a year during the Annual Enrollment Period (October 15 to December 7), so choosing the wrong plan is not permanent.
  • Plans that cover dental, vision, or hearing are common but vary by region, so check what your plan includes before you assume it is covered.

How to use Medicare.gov's Plan Finder to compare plans

The Plan Finder is a tool on Medicare.gov where you enter your zip code, the doctors you see, and your prescription drugs, and it shows you which plans in your area cover them. Go to Medicare.gov, click "Find Care Providers and Suppliers" or search for "Plan Finder," and select your state and county. You will need your Medicare number, which is on your Medicare card.

Enter each doctor's name and specialty — the tool will tell you whether they are in the plan's network and what your copay would be for a visit. Then add your prescription drugs by name and strength. The tool shows you the monthly premium, the annual deductible, the copay for each drug, and your estimated total yearly cost if you use the plan as you expect to. Write down the top three or four plans and compare them side by side on paper or in a spreadsheet.

If a doctor you use is not in the network, call the plan directly and ask whether they are accepting new patients or whether the plan has a similar specialist nearby. Do not assume the Plan Finder has the most current list — networks change, and a doctor may have left the plan since the tool was last updated.

Understanding copays, deductibles, and out-of-pocket limits

A copay is a fixed amount you pay each time you use a service — for example, $25 for a doctor visit or $15 for a generic drug. A deductible is the amount you have to pay out of your own pocket before the plan starts to help pay. An out-of-pocket limit is the most you will have to pay in a year; once you reach it, the plan pays for the rest of your care.

A plan with a $0 monthly premium might have a $500 deductible and $50 copays, while a plan with a $150 monthly premium might have a $0 deductible and $20 copays. If you see a doctor once a year, the first plan saves you money. If you see a doctor monthly and take several drugs, the second plan probably costs less overall. The Plan Finder estimates your total yearly cost based on your actual doctors and drugs, so use that number to compare, not just the monthly premium.

The out-of-pocket limit is important if you have a serious illness or need surgery. In 2024, Medicare Advantage plans must cap your out-of-pocket costs, though the limit varies by plan. Once you hit that limit, the plan covers 100 percent of your care for the rest of the year. Ask each plan what its out-of-pocket limit is and whether it includes drugs.

Checking whether your doctors and hospitals are in the plan's network

Medicare Advantage plans use networks — lists of doctors, hospitals, and other providers that have agreed to work with the plan. If you go to a doctor outside the network, you pay much more, and some plans do not cover out-of-network care at all except in emergencies. Before you enroll, confirm that your primary care doctor, any specialists you see regularly, and your preferred hospital are all in the plan's network.

Use the Plan Finder to check, but also call the plan's customer service number and ask directly. Tell them your doctor's full name and ask whether that specific doctor is accepting new Medicare Advantage patients. Networks change — a doctor may have left the plan, or the plan may have stopped accepting new patients at that location. A phone call takes five minutes and can save you from choosing a plan that does not include your doctor.

If your main doctor is not in a plan's network but you like the plan otherwise, ask whether the plan will make an exception and cover that doctor anyway. Some plans will do this, especially if there is no similar doctor nearby in the network. Get any exception in writing before you enroll.

How prescription drug coverage works in Medicare Advantage plans

Every Medicare Advantage plan includes prescription drug coverage — you do not need a separate Part D plan. However, each plan decides which drugs it covers and what you pay. A drug might be covered by one plan but not another, or it might have a $10 copay in one plan and a $50 copay in another.

Use the Plan Finder to check your specific drugs. Enter each drug by name and strength, and the tool will show you the copay for each plan. If a drug you take is not covered, ask the plan whether you can request an exception — sometimes the plan will cover a drug if your doctor writes a letter explaining why you need it. If the plan will not cover it, you may need to switch to a different plan or talk to your doctor about taking a similar drug that the plan does cover.

Plans can change their drug coverage each year, so even if your drugs are covered now, check again during the Annual Enrollment Period before you re-enroll. A drug you have been taking for free might move to a higher copay tier, or it might be dropped from the plan entirely.

Extra benefits like dental, vision, and hearing coverage

Many Medicare Advantage plans include coverage for dental, vision, and hearing — services that Original Medicare does not cover. However, not all plans include these benefits, and the coverage varies widely. One plan might cover two cleanings and one exam per year; another might cover cleanings, exams, and fillings. Vision coverage might mean an eye exam and glasses, or just an exam.

If dental, vision, or hearing coverage matters to you, check what each plan offers. The Plan Finder shows these benefits, and you can also call the plan to ask for details. Be aware that these benefits often come with limits — for example, a plan might cover one pair of glasses every two years, or dental coverage might have a yearly maximum of $1,000. If you need significant dental or vision work, ask the plan whether it covers that specific service before you enroll.

When you can change plans and what to do if you choose the wrong one

You can change Medicare Advantage plans once a year during the Annual Enrollment Period, which runs from October 15 to December 7. If you enroll in a new plan during this period, your coverage starts on January 1. You can also switch plans if you move to a new state or county, or if you lose your current plan for certain reasons.

If you enroll in a plan and realize it was the wrong choice — your doctor left the network, or a drug you need is not covered — you have a few options. If you are still in your first year with the plan, you may be able to switch to a different plan outside the Annual Enrollment Period. Call Medicare at 1-800-MEDICARE to ask whether you may have access to for a Special Enrollment Period. If you do not may have access to, you will have to wait until October to change plans.

To switch plans, you enroll in the new plan during the Annual Enrollment Period. You do not have to contact your old plan — Medicare handles the switch automatically. Your new coverage starts on January 1 of the following year.

Questions to ask the plan before you enroll

Before you enroll, call the plan's customer service number and ask these questions: Is my primary care doctor in your network and accepting new Medicare Advantage patients? Are my specialists in your network? What is the copay for a primary care visit and a specialist visit? What is your annual deductible and out-of-pocket limit? Are my prescription drugs covered, and what are the copays? Do you cover dental, vision, and hearing, and what is included? What happens if I need emergency care while traveling outside your service area?

Write down the answers and compare them across the plans you are considering. If a plan representative cannot answer a question, ask for the answer in writing before you enroll. Do not enroll in a plan based on what you think it covers — confirm it first.

Frequently Asked Questions

Can I switch Medicare Advantage plans if I realize I made a mistake?

Yes, but only during the Annual Enrollment Period (October 15 to December 7) or if you may have access to for a Special Enrollment Period. If you move to a new state or county, or if your plan leaves the market, you can switch outside the enrollment period. Call Medicare at 1-800-MEDICARE to ask whether your situation qualifies.

What if my doctor leaves the plan's network after I enroll?

If your doctor leaves the plan, you may may have access to for a Special Enrollment Period that lets you switch plans outside the normal enrollment window. Call your plan and Medicare to report the change. Your plan should also notify you if a doctor leaves the network.

Do all Medicare Advantage plans cover the same drugs?

No. Each plan decides which drugs it covers and what you pay. A drug covered by one plan may not be covered by another, or it may have a different copay. Always check your specific drugs in the Plan Finder before you enroll.

What is the difference between in-network and out-of-network care?

In-network providers have agreed to work with the plan and charge the copay you see in the plan documents. Out-of-network providers have not agreed to work with the plan, and you pay much more — sometimes the full cost. Some plans do not cover out-of-network care at all except emergencies.

How do I know if a plan is available in my area?

Use the Plan Finder on Medicare.gov and enter your zip code. The tool shows all Medicare Advantage plans available where you live. Plans vary by county, so even if a plan is available in your state, it may not be available in your specific area.