How to Choose the Best Medicare Advantage Plan for Your Needs

Coinsurance, the percentage you’re billed from a provider after a plan has paid, is also common, especially for out-of-network services and higher-cost prescriptions.

In 2026, the out-of-pocket spending limit, which includes copayments, coinsurance and deductibles for medical care but not premiums or drug costs, must not exceed $9,250 for in-network care and $13,900 total for covered in-network and out-of-network services.

Some plans have lower limits, and KFF says the 2026 average for all Medicare Advantage enrollees, who often pick their plans based on costs, was $5,421 for in-network services and $9,825 for in- and out-of-network care combined.

Drug costs, if you’re choosing a plan with prescription coverage, also should figure into your equation.

Using Medicare Plan Finder, you can type in your zip code, prescriptions and some preferred physicians to get a set of plans available in your area that can be ranked or filtered using your preferences. You’ll also see links in the search results that allow you to compare two or three plans side by side.

To get all the details about one plan, click on the See Plan Details button, then the Benefits & Costs tab to see copayments for primary doctor and specialist visits, diagnostic tests, lab services, diagnostic radiology services such as MRIs, X-rays, emergency care, urgent care, inpatient and outpatient hospital coverage, physical therapy and other services.

The plan finder is helpful in figuring out which pharmacies near you and through the mail can offer your lowest total prescription costs. If you want to find out specifics about each medication, the plan finder lets you do that by clicking See Plan Details, then scrolling to the Drug Coverage section and Estimated drug costs by pharmacy. Each of the meds you added will be listed.

Ways to save. If your out-of-pocket drug costs exceed $2,100 in 2026 or $2,400 in 2027, you won’t have to pay more, thanks to the 2022 prescription drug law supported by AARP. This holds true for everyone with Medicare drug coverage, both Medicare Advantage and stand-alone Part D plans.

If you’d like some money put toward your monthly Part B premium, some plans offer a rebate. Less than 20 percent of plans included this feature in 2026, varying from a small reduction to something more substantial, according to a study in JAMA Health Forum.

It’s part of the mix of benefits that Medicare Advantage plans can offer using federal payments they receive. They can use the money for adding supplemental benefits, giving a rebate for Part B premiums, lowering out-of-pocket limits or reducing Part D premiums.

3. Make sure your doctors, hospitals are in-network

If you like your doctors and want to keep them, discovering whether they and the hospitals they use — or you prefer — participate in a plan will be an important part of keeping your costs down.

One way Medicare Advantage plans control costs is through limited provider networks. And when insurers offer different plans in the same coverage area, sometimes those plans have different lists of providers.

Some enrollees have access to more doctors in their area than others, but on average, they had about half the doctors available to those in original Medicare, according to a 2025 KFF report.

When you find your doctors’ and hospitals’ names in Medicare Plan Finder on some plans you’re considering, your job isn’t over.

In the past, plans’ websites weren’t always kept up to date. The promise of provider listings in the plan finder for Medicare Advantage was full of glitches during open enrollment last year, but the Centers for Medicare and Medicaid Services (CMS) is using a different method this year.

Use the information as one tool to help you figure out whether your doctors participate in plans that look good to you.

Then check with your doctors. Be aware that physicians with several offices in an area might be in-network at one location but out-of-network at another.

Confirming their status can be tedious. But not verifying could mean they really aren’t part of a plan you’re considering, and to continue in their care could mean high copayments or having to pay for all their treatments yourself.

4. Find out if and how your drugs are covered

If you’re like most Medicare enrollees, the 2026 $2,100 out-of-pocket cap for prescription drugs, $2,400 in 2027, is a safety net but a limit you don’t expect to reach.

Still, you don’t want to spend hundreds of dollars more for what you need if you can avoid it. That’s why you need to understand how all Medicare drug plans are structured.

First, make sure your medications are on a plan’s drug list, called a formulary. That’s one reason to put all your prescriptions into Medicare Plan Finder.

If you create a login, you can save your list and change it as your needs change. And a plan with low or no additional premiums might be more expensive overall because of your prescription costs.

You probably know that some of your meds have higher costs than others. Each plan negotiates with drug manufacturers and pharmacies.

What you pay is based on those agreements, and Medicare gets its say too.

Most insurers today, in Medicare or plans for the rest of the market, use four or five pricing tiers. Sometimes the last two tiers are combined:

• Tier 1, preferred generic drugs
• Tier 2, nonpreferred generic drugs
• Tier 3, preferred brand-name drugs
• Tier 4, nonpreferred brand-name drugs
• Tier, 5, specialty drugs

Whether a generic or brand-name drug is preferred often depends on those behind-the-scenes negotiations, and the outcome will differ depending on the plan. You’ll also notice varying costs among pharmacies near you, depending on whether a plan has classified them as preferred, in-network or out-of-network.

Generally, preferred pharmacies, often mail-order operations, are the least expensive, but that’s not always true. Check the details for each of your medications in the plan finder.

Click the See plan details button. Then scroll down to Drug Coverage, where you’ll see a lot of details, including estimated drug costs by pharmacy, estimated drug + premium cost, estimated total monthly drug cost and estimated drug costs that include the retail cost and cost after deductible.

Click on + View more drug coverage and you’ll see in what tier your prescriptions are classified and the cost of a one-month copay for each tier. The other drug information section shows you whether the plan requires prior authorization or step therapy before a medication is covered and any quantity limits.

5. Evaluate plans’ extra benefits carefully

Nearly all Medicare Advantage plans offer some coverage for dental, hearing and vision care, KFF says, benefits not available in original Medicare. But the scope isn’t uniform among plans or even year after year in the same plan.

Plans may cite preventive care such as teeth cleaning but leave you with a big bill for more extensive work such as a root canal or dental implant. Often, you’ll see an allowance for a particular benefit, such as $150 every two years for a pair of eyeglass frames within a plan’s network of providers.

More than 9 in 10 plans have fitness benefits. But availability is less for a health supplies stipend, commonly called a flex card, or one for meals, known as a grocery allowance, and plans don’t always offer these to every member.

6. Consider special needs plans if you qualify

Medicare Advantage special needs plans (SNPs) provide extra benefits and coordinated care for people with chronic medical conditions. Almost a quarter of Medicare Advantage enrollees were in these plans in 2026.

• Chronic condition SNPs are specifically designed for enrollees who have at least one of more than a dozen severe or disabling diseases such cancer, chronic heart failure, dementia, diabetes or kidney failure. Most people are in plans for cardiovascular conditions or diabetes.
• Dual eligible SNPs are for enrollees with low income and assets who are eligible for both Medicare and Medicaid. Almost 4 of 5 SNP enrollees are in these plans.
•  Institutional SNPs are for those who need hands-on care for 90 days or more in places such as long-term care centers, nursing homes or rehabilitation hospitals. They can live at home but need the same high level of care found in those facilities.

All these plans must offer prescription coverage, and you may be able to keep your primary care doctor or another provider you like by asking plan officials if you can keep them.

These are Medicare Advantage plans, so you may be required to receive prior authorization before a complicated or expensive treatment. But you won’t face reauthorization hoops as long as the treatment is considered medically necessary.

7. Look at the star ratings for each plan of interest

The Centers for Medicare and Medicaid Services gives both Medicare Advantage and stand-alone Part D plans star ratings. Five stars, ★ ★ ★ ★ ★, is the best and the most rare.

But the ratings really assess private insurers’ Medicare contracts with CMS, contracts that include many plans, says Claire Noël-Miller, senior strategic policy adviser for Medicare at the AARP Public Policy Institute.

About 2 in 5 contracts received four stars or more, enough of a sign of quality that CMS gives each contracting company a bonus. Eighteen contracts, representing about 820,000 enrollees, were rated five stars in 2026, according to CMS. That’s about 2 percent of all who are in Medicare Advantage plans.

But because a star rating you see in the plan finder covers multiple plans, measuring the quality of a specific plan isn’t possible, Noël-Miller says. The ratings don’t reflect improper prior authorization denials or unnecessary hospitalizations because enrollees’ chronic conditions were ineffectively managed.

And often the five-star plans have fewer than half of the doctors in their provider networks than are available to original Medicare enrollees, KFF says.

Another catch: No five-star plans may be located in your area.

What these rare plans have going for them is special dispensation to switch to them at any time. This is also true of five-star stand-alone Part D plans that pair with original Medicare. So the stars are worth considering but shouldn’t be your sole criterion for choosing a plan.

8. Think about your long-term needs

Enrolling in a Medicare Advantage plan can be a long-term commitment even if you’re not thinking 20 years into the future.

Thanks to your employer’s health insurance, you’re likely familiar with HMOs and PPOs, the same types of plans offered through Medicare Advantage. Today only about 1 percent of covered workers are at companies with traditional plans more like original Medicare, according to KFF’s 2025 Employer Health Benefits Survey.

If you’re choosing Medicare Advantage because of its annual cap on out-of-pocket costs, remember that the trade-off may be limited provider networks and prior authorization requirements that aren’t common in original Medicare. Medicare Advantage plans also can change their costs, provider networks and benefits from year to year.

As you get older, you may need more specialists, more frequent care or treatment at medical centers outside your plan’s network.

While you can switch back to original Medicare later, buying a Medigap supplement policy may not be as easy. In most states, insurers can use your health history to deny coverage or charge higher premiums if you apply outside your Medigap open enrollment period.

Financial help is available for both Medicare Advantage and original Medicare if you have limited resources:

• Medicare Savings Programs, which you can apply for at your state’s Medicaid office, can help with Part B and even Part A premiums.
• The Extra Help program, which you can apply for through the Social Security Administration (SSA), can help with prescription costs.

If your monthly budget is tight, the Medicare Prescription Payment Plan will let you spread out your medication payments throughout a calendar year interest-free rather than paying all at once.

Your State Health Insurance Assistance Program (SHIP), federally financed but locally maintained in your state or territory, offers personalized help with sorting through your options. The toll-free national number, 877-839-2675, can connect you with your local SHIP, or you can find your area’s SHIP through an online directory.

9. Now you’re ready to enroll

To enroll, head back to Medicare’s Plan Finder and locate the plan you like best. Click the Enroll button.

You’ll need your Medicare number, the dates your Medicare coverage began and effective dates for Medicare Parts A and B. You’ll also be asked about any other health insurance and when you want the new coverage to begin.

The application screens will guide you through the remaining steps.

This story, originally published July 27, 2022, now includes the steps needed to evaluate plans after the decision to choose Medicare Advantage.