How to Compare Medicare Advantage Plans | Smarter Plan Picks

Match your doctors and meds first, then compare yearly spending limits, visit costs, drug restrictions, and quality ratings.

Medicare Advantage plans can sound alike when you’re shopping. The fine print is where your real cost and access live. One plan may treat your hospital as in-network, another may not. One may price your refill as a small copay, another may place it behind paperwork.

This guide gives you a repeatable way to compare plans so your choice fits your care and your budget.

How Medicare Advantage Works In Plain Terms

Medicare Advantage (Part C) plans are offered by private insurers that contract with Medicare. When you enroll, the plan manages your Part A and Part B services through its network and its own cost-sharing schedule. Many plans also include Part D drug benefits.

Your day-to-day experience usually comes down to where you can get care and what you pay when you get it. That means networks, referrals, copays, coinsurance, and the plan’s yearly spending cap for Part A and B services.

What To Collect Before You Start

Set up a short list so you don’t rely on memory while comparing.

• Doctors and facilities: primary doctor, specialists, hospital, urgent care.
• Prescription list: drug name, dose, frequency, and your pharmacy.
• Care pattern: visit count, labs, imaging, therapy, and any hospital stay from last year.
• Non-negotiables: a specific doctor, hospital system, or medication.

How to Compare Medicare Advantage Plans Step By Step

Run each plan through the same steps. It keeps your notes clean.

Step 1: Use Medicare’s Official Plan Finder

Start with the Medicare Plan Finder. Enter your zip code, add your prescriptions, and select your pharmacies. Save your top choices so you can check them one by one.

Step 2: Lock Down Network Access For Your Doctors

Directories change, so confirm what matters to you.

1. Search the plan’s provider directory for your doctor and your hospital.
2. Call the doctor’s office and ask: “Do you accept this plan next year under this exact plan name?”
3. Ask if specialist visits need a referral from your primary doctor.

If you travel often, write down what the plan pays for routine care away from home.

Step 3: Check Drug Fit Beyond “Yes, It’s Listed”

Drug benefits aren’t just a list. You want to know your cost and any restrictions.

• Tier: ties to your copay or coinsurance.
• Restrictions: prior authorization, quantity limits, step therapy.
• Pharmacy status: preferred vs standard can change your price.

If a drug needs prior authorization, ask your prescriber’s office how they handle requests and how long approvals usually take with that insurer.

Step 4: Pull The Numbers That Shape Your Year

For each plan, write the same set of numbers on one page.

• Monthly plan charge (if any), plus your Part B monthly payment.
• Primary care and specialist visit copays.
• Emergency room and ambulance copays.
• Inpatient hospital cost sharing (per day or per stay).
• Outpatient surgery and imaging cost sharing.
• Yearly spending cap for Part A and B services (often called MOOP).

The spending cap is the guardrail that limits Part A and B cost sharing in a bad medical year. Some PPO plans list one cap for in-network care and a separate, higher cap that includes out-of-network care. Write down both if they exist.

Step 5: Compare Quality Ratings The Same Way Each Time

Medicare publishes Star Ratings. You can view them in Plan Finder’s Star Ratings view. Use ratings as a tiebreaker after you’ve checked doctor access, drug fit, and costs.

Documents To Use For Final Decisions

Plan documents are where the terms live. Most plans provide:

• Summary of Benefits: a quick grid of costs and benefits.
• EOC document: the full rulebook for access and cost sharing (often labeled “EOC” by the plan).
• Drug formulary: the drug list, tiers, and restrictions.
• Provider directory: doctors, hospitals, and facilities in the network.

If you want a Medicare overview while you shop, read the official Medicare & You handbook (PDF).

Comparison Checklist For Reading Plan Documents

Fill this in for each plan. It keeps you from missing a deal-breaker.

Item To Compare	Where To Find It	What To Write Down
Plan type	Summary of Benefits	HMO, PPO, or SNP
Referral rules	EOC document	Referral needed: Yes/No
Visit costs	Summary of Benefits	Primary and specialist copays
Hospital stay costs	Hospital services section	Per day or per stay
Skilled nursing costs	Post-acute section	Days paid for and daily cost
Yearly spending cap	Summary of Benefits	In-network cap, plus any combined cap
Drug tier and restrictions	Formulary	Tier and any limits
Out-of-network terms	EOC document	Routine care paid: Yes/No, plus member share
Authorization list	EOC document or plan policy pages	Services tied to your care

How To Estimate A Realistic Yearly Cost Range

You don’t need perfect forecasting. You need a side-by-side estimate that reflects how you use care.

Make Two Scenarios

• Low-use: routine visits, stable meds, a few labs.
• High-use: specialist visits, imaging, a procedure, or a hospital stay.

For each plan, add up:

• 12 × monthly plan charge.
• Your expected visit copays.
• Your expected drug spending from Plan Finder at your pharmacy.
• One likely big item using the plan’s cost-sharing terms.

In a high-use year, your total can approach the spending cap. When that happens, the cap is often the best single number to compare across plans.

Spot Price Triggers That Swing Totals

• Coinsurance: a percentage can vary by facility price.
• Per-day hospital charges: costs may change after a certain day count.
• Out-of-network shares: your share may jump outside the network.

Quick Call Script For Plan And Provider Offices

Short calls can save you from a bad switch. Keep it simple and write answers down.

• To a doctor’s office: “Can you confirm you take this plan next year? I’m checking the exact plan name and network.”
• To a hospital billing office: “Is this plan in-network for your facility? If yes, do you bill the plan under this tax ID?”
• To the plan: “For this service code, is my share a flat copay or coinsurance? Does it need prior authorization?”

If you get a “maybe,” ask who can give a firm answer. Some offices can check through their eligibility tools. For plans, ask for the page or section name in the EOC document so you can confirm it yourself later.

How To Compare Authorization Lists Without Getting Lost

Authorization requirements can feel long and messy. Don’t read the full list unless you love paperwork. Start with the services tied to your care: imaging, outpatient surgery, therapy, sleep studies, and durable medical equipment.

Then make two notes for each plan: what needs approval and how approvals are requested. Some plans accept electronic requests from clinics. Others still rely on forms and fax. That workflow can affect how fast you get scheduled.

Extras That Matter Only After Medical Fit

Many plans offer extras such as dental, vision, hearing, rides, or meal benefits. Perks are nice, but don’t let them hide weak doctor access, drug restrictions, or high cost sharing.

Dental, Vision, And Hearing Limits

Read the dollar caps and the network terms. If you already have a dentist, verify network status before you lean on that benefit.

Travel And Multi-State Living

If you split time between states, pay close attention to routine care away from home, not just emergency care.

Authorization And Paperwork Load

If your care relies on imaging, therapy, outpatient procedures, or durable medical equipment, read the authorization section and ask your doctors if they run into delays with that insurer.

Side-By-Side Notes Template For Final Picks

When you’re down to two or three plans, keep your notes consistent.

Category	Plan A	Plan B
Doctors and hospital match	Yes/No plus referral rule	Yes/No plus referral rule
Drug fit at your pharmacy	Yearly estimate and restrictions	Yearly estimate and restrictions
Hospital stay cost	Per day or per stay terms	Per day or per stay terms
Yearly spending cap	In-network cap and any combined cap	In-network cap and any combined cap
Star Rating	Overall rating	Overall rating
Extras you will use	Dental/vision/hearing notes	Dental/vision/hearing notes
Deal-breakers	Anything that stops you	Anything that stops you

Common Mistakes That Lead To Regret

These issues show up often when people switch plans.

Picking Based On The Monthly Charge Only

A low monthly charge can sit next to high copays and a high spending cap. Always compare the cap and hospital cost sharing alongside the monthly price.

Skipping A Fresh Drug Check Each Year

Drug lists can change each year. If you rely on one medication, confirm its tier and restrictions for the new plan year.

Assuming Away-From-Home Care Works The Same

Emergency care is straightforward. Routine care away from home can be limited. If you spend months away, read that section before enrolling.

Where To Get Unbiased Help

If you want a second set of eyes, SHIP offers free, one-on-one help. ACL lists SHIP details on its SHIP program page.