There is no single "best" Medicare Advantage plan — the right one depends on your doctors, medications, and budget

Medicare Advantage plans (also called Part C) are sold by private insurers and bundle your hospital, doctor, and prescription drug coverage into one plan. Each plan has different doctors in its network, different out-of-pocket costs, and different rules about which medications it covers. A plan that works well for one person may cost another person far more or exclude their doctor entirely.

The plans available to you, and their costs, change every year. For 2025, you will need to compare the plans offered in your area during the annual enrollment period (October 15 through December 7, 2024) to find which one fits your situation. This guide explains what to look for and how to compare.

Key Takeaways

  • The best plan for you depends on which doctors and hospitals you use, which medications you take, and how much you can afford to pay out of pocket.
  • You can only change plans during the annual enrollment period (October 15 through December 7 each year) unless you have a may have access to life event.
  • Medicare.gov's plan comparison tool lets you enter your doctors and medications to see which plans cover them and what you would pay.
  • Plans with $0 premiums often have higher deductibles and copays, so comparing total out-of-pocket costs matters more than comparing premiums alone.
  • If you are satisfied with your current plan and it is still offered, you can do nothing and your coverage continues into 2025.

How to use Medicare.gov to compare plans for your situation

Go to Medicare.gov/plan-compare and enter your zip code. The tool will show all Medicare Advantage plans available in your area for 2025. You will see the monthly premium, deductible, and copays for each plan listed side by side.

To make the comparison meaningful for your life, add your doctors and medications. Click "Add your doctors" and search by name or by the hospital or clinic where they work. The tool will tell you whether each plan includes that doctor in its network. Do this for your primary care doctor, any specialists you see regularly, and your preferred hospital or urgent care clinic.

Then click "Add your medications" and enter each prescription drug you take. The tool shows you the copay or coinsurance for each drug under each plan. This step often reveals big differences — one plan might cover your blood pressure medication for $5 a month while another charges $40.

After you add your doctors and medications, sort the results by "Estimated Annual Out-of-Pocket Costs" rather than by premium. This number includes the monthly premium, deductibles, copays, and coinsurance you would likely pay in a year. It is the truest picture of what the plan will cost you.

Understanding premiums, deductibles, and copays

The monthly premium is what you pay to the insurance company each month, separate from your Medicare Part B premium. Many Medicare Advantage plans have $0 premiums, meaning you pay nothing monthly. However, a $0 premium does not mean the plan is free — you still pay deductibles and copays when you use care.

The deductible is the amount you must pay out of your own pocket before the plan starts to help pay for care. Some plans have no deductible for doctor visits but do have a deductible for hospital stays. Others have a single deductible that applies to all care. A plan with a $0 premium often has a higher deductible — sometimes $500 or more — to balance out the lower monthly cost.

A copay is a fixed dollar amount you pay each time you use a service — for example, $25 for a doctor visit or $10 for a generic prescription. A coinsurance is a percentage of the cost you pay instead. For example, you might pay 20% of the cost of an MRI after you meet your deductible. Plans vary widely in these amounts, which is why entering your own doctors and medications into the comparison tool matters.

What to check before you switch plans

Before you enroll in a new plan, verify three things: that your doctors are in the network, that your medications are on the formulary (the plan's list of covered drugs), and that you understand the out-of-pocket costs.

Call your doctor's office directly and ask, "Do you accept [Plan Name] Medicare Advantage?" Do not rely only on the Medicare.gov tool, because networks change and the tool is sometimes outdated. If your doctor is not in the network, ask whether they will be in 2025 or whether they can refer you to someone in the plan who treats the same condition.

For medications, look at the plan's formulary document on its website. The Medicare.gov tool shows copays, but the formulary tells you whether the plan requires you to try a cheaper drug first (called a step therapy) or whether it limits how many pills you can get at once. These restrictions can affect how you take your medication.

Also check whether the plan has an out-of-pocket maximum. Once you reach this amount in a year, the plan pays 100% of your costs for the rest of that year. Most Medicare Advantage plans have a maximum, but the amount varies — it might be $6,700 or $8,000 or higher. If you have chronic conditions and expect high medical costs, a plan with a lower out-of-pocket maximum protects you from unlimited expenses.

Special plan types: HMO, PPO, and PFFS

Medicare Advantage plans come in different network types, and the type affects how much freedom you have in choosing doctors and hospitals.

HMO (Health Maintenance Organization) plans require you to use doctors and hospitals in their network. You must choose a primary care doctor who coordinates your care and gives referrals to specialists. If you go to an out-of-network doctor without a referral, the plan will not pay. HMO plans usually have lower premiums and copays because the insurance company controls costs by limiting which providers you can see.

PPO (Preferred Provider Organization) plans let you see any doctor or hospital, but you pay less if you use doctors in the network. You do not need a primary care doctor or referrals. PPO plans cost more in premiums and copays because you have more freedom, but they are useful if you travel, see specialists frequently, or want to keep a doctor who is not in an HMO network.

PFFS (Private Fee-for-Service) plans are rare but work differently: the plan negotiates rates with individual doctors rather than contracting with a network. You can see any doctor who agrees to accept the plan's payment rate. These plans are uncommon and available in only a few areas.

When you can change plans and what happens if you miss the important date

The annual enrollment period for Medicare Advantage runs from October 15 through December 7 each year. Any changes you make during this window take effect on January 1 of the following year. If you enroll in a new plan, your old plan coverage ends on December 31.

If you miss the October 15 to December 7 window, you cannot change plans until the next year's enrollment period — unless you have a may have access to life event. These events include losing your job, moving to a new state, getting married or divorced, or having a significant change in your health. If you experience a may have access to event, you have 60 days to make a change. Contact Medicare at 1-800-MEDICARE to report the event and confirm you are may be able to access to change plans outside the annual period.

If you do nothing during the enrollment period and your current plan is still offered in 2025, you will automatically stay in that plan. Your coverage continues without a gap. However, the plan's costs, network, and formulary may change for 2025, so it is worth reviewing your current plan even if you plan to keep it.

Questions to ask your doctor or plan before you enroll

Before you commit to a plan, ask your doctor's office these questions: Does the office accept this plan? Will the doctor be in the plan's network in 2025? If not, can the office refer you to someone in the plan? How long does it take to get an appointment?

Call the plan's customer service number (on its website) and ask: What is the process for getting a referral to a specialist? How do I request an exception if my medication is not on the formulary? What happens if I need emergency care while traveling? Does the plan cover telehealth visits, and if so, what is the copay?

These conversations take time but prevent surprises after you enroll.

Frequently Asked Questions

Can I switch Medicare Advantage plans in the middle of the year?

No, unless you have a may have access to life event such as losing your job, moving to a new state, getting married or divorced, or a major change in your health. Otherwise, you can only change plans during the annual enrollment period from October 15 through December 7. If you have a may have access to event, contact Medicare at 1-800-MEDICARE within 60 days to make a change.

What if my doctor leaves the plan's network during the year?

If your doctor leaves mid-year, the plan must give you notice. You can request an exception from the plan to keep seeing that doctor at the in-network copay, or you can wait until the next annual enrollment period to switch to a different plan. Contact the plan's customer service to ask about your options.

Do I still pay my Medicare Part B premium if I have Medicare Advantage?

Yes. You pay your Part B premium to Medicare, and then you pay the Medicare Advantage plan's premium (if it has one) to the insurance company. Some Medicare Advantage plans have $0 premiums, so you would only pay your Part B premium, but you still owe Part B.

What if I cannot find a plan that includes my doctor?

If no Medicare Advantage plan in your area includes your doctor, you have two options: enroll in Original Medicare (Part A and Part B) instead and buy a separate Medigap or Part D plan, or ask your doctor whether they will see Medicare Advantage patients outside the network. Some doctors do this, though you may pay more out of pocket. Discuss this with your doctor before the enrollment period ends.

How do I know if a plan's out-of-pocket maximum is good?

For 2025, the maximum out-of-pocket limit for Medicare Advantage is set by Medicare, but individual plans may have lower limits. Compare the out-of-pocket maximums across the plans you are considering. If you have chronic conditions or take many medications, a lower maximum protects you if your medical costs are high. If you are generally healthy, the maximum matters less, but it is still worth checking.