How to compare Medicare Advantage plans without being sold to

You don't need an agent to compare Medicare Advantage plans well. You need your own list of doctors, hospitals, and drugs, and a few minutes with the filed facts. Here's a neutral, step-by-step way to do it — the same order a careful buyer uses.

1. Start with your doctors

A plan is only as good as whether it covers the people who already care for you. Before you look at premiums, list your doctors, then check each plan's own provider directory or call the office and ask if they take that specific plan for the coming year. Networks change every January, so last year's answer isn't this year's.

2. Check your hospitals

Do the same for the hospital and any specialists you rely on. An HMO generally covers only in-network hospitals except in an emergency; a PPO covers out-of-network care at higher cost. If a hospital you need is out of network, that plan may not be for you regardless of its extras.

3. Check your drugs

Look up each of your prescriptions in the plan's formulary. What matters is the tier it sits on and whether it carries prior authorization, step therapy, or a quantity limit. On this site you can search a drug and see the tier and restrictions for every plan in your county at once.

4. Check your pharmacy

The same drug can cost less at a preferred pharmacy than at a standard one in the same plan. Check that a pharmacy near you is preferred, or that the plan's mail-order option works for you.

5. Weigh premium against total cost

A $0 premium is not a $0 plan. What you actually spend is the premium plus the copays, coinsurance, and deductibles you'll hit given your own care. A plan with a small premium but high specialist copays can cost more than a plan with a modest premium and low cost sharing.

6. Look at the out-of-pocket maximum

The MOOP is the most you can pay in a year for covered medical care — your ceiling if something goes badly wrong. A lower MOOP is real protection. Original Medicare has no such limit; a Medicare Advantage plan's is one of its most important numbers.

7. See past the dental and OTC headlines

Extra benefits are where marketing concentrates. A "$2,000 dental" or a large over-the-counter card sounds big, but the value depends on annual maximums, what's actually covered, networks, and how often you'd use it. Treat these as tie-breakers after doctors, drugs, and cost, not as the headline.

8. Read the Summary of Benefits

The Summary of Benefits is the short, standardized document that lays out a plan's costs and benefits. This site links each plan's SoB from the carrier's own site. Read it before you decide; the Evidence of Coverage is the full legal detail.

9. Understand referrals and prior authorization

Many HMOs require a referral to see a specialist, and many plans require prior authorization before covering certain services. Neither is bad on its own, but they shape how easily you'll get care. Since 2026, plans must decide expedited prior-authorization requests within 72 hours and standard ones within 7 days.

10. Account for how you live

If you travel or spend part of the year elsewhere, a PPO or a plan with broad national access may serve you better than a tight local HMO. If you're eligible for a Special Needs Plan (for people with Medicaid, a qualifying chronic condition, or who live in a nursing home), those plans are built around those needs.

11. Use star ratings carefully

star ratings measure a plan's contract on quality and member experience. They're a useful signal, not a verdict on your situation — a 4-star plan that doesn't cover your doctor is still the wrong plan for you.

12. Confirm before you enroll

Filed data can change. Before enrolling, confirm the details with the plan, Medicare.gov, your State Health Insurance Assistance Program (SHIP), or 1-800-MEDICARE. All three are free and none of them sell plans.

A buyer's checklist

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