Every fall, Medicare Advantage plans compete for your attention. Television commercials pitched by celebrities, texts, and mailers promise low or even $0 monthly premiums, dental and vision benefits, fitness programs, transportation, food allowances and other extras. It can be tempting to compare plans by asking one simple question: Which one gives me the most for the least money?
That is an understandable place to start—but it is not the best way to choose a Medicare Advantage plan.
Medicare Advantage (MA) plans are offered by private insurance companies that contract with Medicare. They must cover Medicare-covered Part A and B services, subject to Medicare’s rules, but they can have different cost-sharing requirements, provider networks and procedures for accessing care. Most include Part D prescription drug coverage.
Medicare Advantage plans work very differently from Original Medicare. The good news: Medicare Advantage plans offer tempting perks:
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- Caps out-of-pocket yearly spending costs, unlike Original Medicare.
- Offers a variety of typically attractive extra benefits, such as hearing aids, eye exams, dental cleanings, gym memberships, transportation, or other benefits beyond what Original Medicare generally covers;
- May have lower upfront costs and offer $0 plan premiums;
- Offers simplicity, one-stop coverage for Part A and Part B and often Part D prescription drug coverage under one plan rather than requiring separate decisions about supplemental plans and prescription drug coverage.
- Lower monthly premiums for prescription drug coverage, unlike the standalone Part D premiums under Original Medicare (although the plan’s drug formulary and cost-sharing rules still matter.
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The bad news: most MA plans use primarily HMOs and PPOs provider networks. This can be challenging for retirees. HMOs generally require you to use in-network providers for routine care, subject to exceptions, and may require referrals. PPOs generally allow some covered out-of-network care at a higher cost, but the rules vary by plan. Prior authorization may also be required for certain services, procedures or medications.
For retirees who travel, divide their time between two locations, or want to keep particular doctors and hospitals, these restrictions can be important.
So there are real advantages – and real tradeoffs.
The question is not simply whether Medicare Advantage is “good” or “bad.” The better question is: Does the particular plan you are considering fit the way you actually use health care? Sticking with the same coverage year after year is not always the best way to manager your health care budget. Look beyond the monthly premium and the attractive extras. Consider your existing doctors and hospitals, medications, anticipated health care needs, provider network restrictions, prior authorization requirements, travel plans, and what you could pay in both an ordinary year and a bad one. Knowing what is driving your decision – and not basing a decision on television ads – will help you focus on choosing –or exploring other plans– that work best for you.
Whether you are new to Medicare or have been enrolled in Medicare Advantage for years, the goal is the same: take the time to review your options and choose the coverage that fits your health care needs, finances and lifestyle —not simply the plan with the most appealing advertisement.
If you need a quick refresher, use the key topics below to jump to the sections you want to review.
Key topics discussed:
- Your Medicare Advantage Action Plan
- Step 1. Read Your Mail First
- Step 2. Make Your List
- Step 3. Pick up to Three Plans to Compare
- Step 4. Know What to Compare – and Why
- Step 5: Put the Numbers Side by Side
- Step 6: Watch for Sales Red Flags
- Step 7: Where to Compare Plans Safely
- Step 8: Know Your Window, and Act
- When Can I Switch My Medicare Advantage Plans? The Yearly Open Enrollment Periods
- Can I Change Plans Outside of the Open Enrollment Period?
- The Medigap Trap: The Curve Ball in Medicare Advantage Plans
- When Might You Be Able to Buy Medigap Without Medical Underwriting?
- Important Restrictions to Keep in Mind
Your Medicare Advantage Action Plan
You don’t need to evaluate every Medicare Advantage (MA) plan available in your ZIP code. A more manageable—and frankly more effective—approach is to narrow the field and compare the things that matter most to you.
Step 1: Read Your Mail First
If you’re already enrolled in Medicare Advantage, start with the Annual Notice of Change (ANOC) from your current plan, sent generally in September. It explains how your current year’s coverage compares with the coverage planned for the coming year, including changes to costs, benefits, provider networks, hospital cost-sharing, prescription drug coverage and other features that take effect in January. Read through this document carefully. Do not assume that because your current plan worked well this year, it will be the same plan next year.
Reviewing your ANOC, rather than letting your plan auto-renew, is one of the most valuable habits you can develop as an experienced Medicare shopper.
Look for changes in: premiums and deductibles; copayments and coinsurance; the medical out-of-pocket maximum; doctor and hospital networks; prescription drug coverage and formulary tiers; preferred pharmacies and drug cost-sharing; prior authorization and referral requirements; extra benefits and service areas. You already know how your current plan works. The question is whether it will work in the same way next year.
Don’t stop at the ANOC
Your plan’s Evidence of Coverage (EOC) document provides more detail about how your plan works, what it covers, and what you will pay. Use it as a reference when the ANOC—or your own health needs—raises a question.
Another way to look it: The ANOC tells you what is changing. The EOC helps explain how the plan works.
Step 2: Make Your List
Before you compare anything, make a personal health care checklist. Gather three things:
- Your providers. List your primary care doctor and specialists, plus the hospitals or facilities you actually use — including outpatient surgery centers, labs, physical or occupational therapy providers, and imaging centers. If you spend part of the year in another state or area, include the providers you use there as well.
- Your medications. Gether a complete list of prescriptions, including dosages and frequency, and the pharmacy you normally use.
- Your anticipated care. Think about any surgery, imaging or diagnostic testing, physical therapy, specialist treatment, infusions, durable medical equipment, regular laboratory work, or ongoing treatment for a chronic condition you may need in the coming year.
Your do not need to predict everything that will happen. The goal is to identify the health care needs most likely to affect your costs and access next year.
A word about provider directories. A provider directory is a starting point, not always the final word. Provider participation can change, and the fact that a doctor accepts an insurance company’s name does not necessarily mean that the doctor participates in the specific Medicare Advantage plan you are considering.
Before you enroll: If keeping a particular doctor or hospital is a deal breaker, confirm their direct participation for the upcoming year by calling your doctor’s office or hospital and check the insurer’s plan-specific directory. Ask about the particular location you use, not just the provider’s name. Medicare’s official plan comparison tool also helps you investigate available coverage and provider information. Verify critical details directly before enrolling.
Step 3: Pick Up to Three Plans to Compare
You don’t need to compare every plan in your ZIP code. Narrow the field immediately by focusing on just:
- Your current plan
- One alternative plan that appears to meet your needs
- A second alternative plan worth considering
If none of the three works, expand the search.
This approach prevents a common Medicare shopping problem: spending hours comparing dozens of plans and becoming so overwhelmed that the easiest choice is simply to bail and do nothing.
Three well-chosen plans are usually more useful than 20 random ones.
Step 4: Know What to Compare — and Why
This is the heart of the research. Do not compare plans based on a single feature. A plan with a $0 premium, for example, may have higher costs elsewhere. A plan with attractive dental benefits may not include your dentist. A plan with your doctor may not include the hospital where you want to receive care. Look at the entire picture.
| Check This |
Why It Matters |
| Your specific doctors | Confirm each doctor is in-network for the exact plan you’re considering for 2027 — not just “yes, that doctor takes our insurance.” A doctor’s participation in one Medicare Advantage plan doesn’t guarantee participation in another plan from the same insurer. |
| Hospitals and other facilities | Check the exact hospitals, outpatient surgery centers, labs, and imaging centers you actually use. Don’t assume that because your doctor is in-network, every facility connected to that doctor is as well. If you split your year between two places, check what happens when you need routine care away from home. |
| Network type | HMOs generally require you to stay in-network for routine care and may require referrals for specialists, with limited exceptions. PPOs may allow some covered out-of-network care, often at a higher cost. Do you need referrals for a specialist? What happens if you go out of network, travel, or have an emergency? Check the rules for the specific plan. |
| Your specific prescriptions | If Part D is bundled in, compare your medications against the plan’s formulary. Check cost tiers for each drug, deductibles, preferred pharmacies, mail-order pricing, prior authorization, step therapy, and quantity limits. A plan that looks inexpensive overall can be costly for your specific prescriptions. |
| Medical annual out-of-pocket maximum | This is your financial safety net for covered Part A and Part B medical services. It is entirely separate from your monthly premiums and prescription-drug costs, which have their own cost-sharing rules under Part D. |
| Premium vs. total cost | A $0 premium plan does not mean $0 health care costs, once you factor in copays, coinsurance, hospital costs, prescription costs, and your medical out-of-pocket maximum. Look at expected costs in a typical year versus a bad one. |
| Prior authorization requirements | Find out specifically whether any services, procedures, tests, medications, or ongoing treatment you anticipate needing require approval before the plan will cover them. Find out how strict the approval process is and how appeals are handled if a request is denied. |
| Star rating | Check the plan’s current rating from Medicare to gauge historical customer satisfaction, access, and reliability. They are useful but they do not guarantee that a plan will meet your particular needs or provide excellent service in every situation. Marketing materials tell you what the insurer wants you to notice — Star Ratings give you another source of information. |
| Extra benefits you’ll actually use | Dental, vision, hearing, transportation, fitness and food benefits are useful, but check the provider networks, annual caps, frequency restrictions, and coverage limits. Will you actually use them? |
| Customer service reputation | Look for independent information about consumer experiences, specifically with claims, appeals, prior authorization and customer service. Consumer experiences can provide perspective, but reviews are not necessarily representative of every member’s experience. |
The question behind every comparison: For each feature, ask: “How would this affect me”?
That simple question keeps the comparison personal. A $20 difference in a specialist copay may not matter much to someone who rarely sees specialists. It could matter considerably to someone seeing one every month. Likewise, a generous dental benefit is less important if your dentist is not in the plan’s network.
Step 5: Put the Numbers Side by Side
Once you know what to look for, write it down. The purpose of the worksheet is not to create a complicated financial model. It is simply to make the differences visible.
For your current plan, use next year’s terms from your ANOC—not what you paid this year.
| Current Plan (2026) |
New Plan (2027) |
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| Monthly premium | ||
| Expected annual cost | ||
| Medical deductible | ||
| Primary-care copay | ||
| Specialist copay | ||
| Hospital costs | ||
| Medical out-of-pocket maximum | ||
| All my doctors in-network (Y/N) | ||
| All my drugs covered (Y/N) | ||
| Prescription costs | ||
| Preferred pharmacy | ||
| Prior authorization requirements foe expected care | ||
| Dental benefit | ||
| Hearing benefit | ||
| Vision benefit | ||
| Over-the-counter allowance | ||
| Transportation | ||
| Other benefits |
What might you spend in a typical year, including premiums and expected cost-sharing? $____
And what might I spend in a bad year? $______
Remember that Medicare Advantage plan’s medical out-of-pocket maximum limits your cost-sharing for covered Part A and Part B services. It does not necessarily include premiums, prescription drug costs, and other services the plan does not cover.
Evaluate plans’ extra benefits carefully: Most Medicare Advantage plans offer some extra coverage for dental, hearing and vision care, fitness benefits, flex cards or meals (i.e., a grocery allowance, not covered by Medicare Part A and Part B). But the scope of these benefits isn’t uniform among plans or necessarily the same from one year to the next.
Use the free-online Medicare Plan comparison tool to search, evaluate and compare your standalone prescription drug plans, estimate the costs of your prescriptions (whether they are generic or brand-name), select the preferred pharmacies near you and check whether your current primary care doctors, specialists, and preferred hospitals are in-network.
Use the tool’s plan-comparison feature to examine two or three plans side-by-side. Be aware that physicians with several offices in an area might participate in a plan at one location but not another.
Step 6: Watch for Sales Red Flags
Television commercials are designed to get your attention. That is not necessarily a problem – but be cautious when the sales pitch becomes more important than your individual needs. Be wary if an insurance agent or salesperson:
- Pushes a specific plan without first asking about your doctors, medications, or health care needs. Good Medicare advice starts with questions about you—not a sales pitch.
- Pressures you to enroll immediately, “before the offer expires”
- Offers to sell you a Medigap policy to supplement a Medicare Advantage plan (the two can’t legally be paired).
- Gives vague answers about whether your specific doctor or hospital is in network
- Cannot clearly explain prior authorization or referral requirements
- Describes a $0 premium as though it means you will have no health care costs
- Shows you a plan with an unusually low premium or unusually broad benefits compared to every other plan in your area — without a clear explanation why
- Tells you what “most people” choose instead of focusing on your personal health needs.
A good adviser should help you understand the tradeoffs, not pressure you into a quick decision.
Step 7: Where to Compare Plans Safely
Start with Medicare’s official Plan Finder tool to compare Medicare Advantage and Part D plans available in your ZIP code side by side. Enter your prescriptions and pharmacies to estimate costs and compare coverage.
Your State Health Insurance Assistance Program (SHIP) offers free, personalized Medicare counseling—a fantastic second opinion before you commit. SHIP counselors are not connected to insurance companies or health plans and can provide an independent second opinion before you comment.
Consumer websites, financial publications and insurance brokers can provide useful explanations and comparisons. But keep in mind that private sites and brokers may have business relationships with insurers. An insurer’s own website—even a reputable one – is a good source for that company’s plan details but it is not a neutral place to compare that company with its competitors.
The safest approach is to use outside sources to generate questions, then verify the actual plan details through Medicare and the plan’s official materials.
Step 8: Know Your Window, and Act
Knowing when you can enroll in or change Medicare coverage is just as important as comparing the plans themselves.
People new to Medicare generally have a seven-month Initial Coverage Election Period (ICEP) around their 65th birthday: the 3 months before turning 65, their birthday month, and 3 months after their birthday. These rules can differ for people who qualify for Medicare earlier or delay enrollment because of qualifying employer coverage.
If you are new to Medicare, pay particular attention to your initial choices. Certain people who try Medicare Advantage and then decide it is not right for them have special rights to return to Original Medicare and obtain Medigap coverage. These rights have specific conditions and time limits.
It you are already enrolled in Medicare Advantage, the fall Annual Enrollment Period and the January-March Medicare Advantage Open Enrollment Period offer opportunities to change coverage. But being allowed to change plans does not automatically mean you can buy a Medigap policy without medical underwriting. This distinction is covered here.
When Can I Switch My Medicare Advantage Plans? The Yearly Open Enrollment Periods
Medicare Advantage (MA) plans change from year to year. Insurers raise costs, change prescription drug coverage, tighten prior authorization rules, modify extra benefits, restrict doctor and hospital networks, or stop offering a plan in specific areas entirely.
Even if your current plan worked well this year, it is worth checking whether it will still meet your needs next year.
There are two main enrollment periods to understand if you are already enrolled in Medicare Advantage:
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- During the yearly Annual Enrollment Period (October 15 – December 7). This is the main fall enrollment period. You can (1) switch to a different Medicare Advantage plan, with or without drug coverage, or (2) drop Medicare Advantage and return to Original Medicare, and join a separate Medicare Part D drug plan (if you want coverage). Coverage starts January 1, if your enrollment request is submitted by December 7.
- During the Medicare Advantage Open Enrollment Period (January 1 – March 31). This is the second opportunity IF you are already enrolled in a Medicare Advantage Plan. You can make one change: (1) switch to a different MA plan, with or without drug coverage or (2) drop your Medicare Advantage plan and return to Original Medicare, with the option to enroll in a separate Medicare Part D drug plan.
Your new coverage generally starts on the first day of the month after the plan receives your enrollment request.
Here is the important distinction: Both periods allow you to reconsider your Medicare Advantage coverage, but neither automatically guarantees that you can buy a Medigap policy if you return to Original Medicare.
That issue deserves special attention before you make a change, particularly if your health needs have increased since you first enrolled in Medicare.
Can I Change Plans Outside of the Open Enrollment Period?
Yes. Certain life events and other qualifying circumstances can give you a Special Enrollment Period (SEP), allowing you to change your Medicare Advantage coverage outside the usual annual enrollment periods. The rules and deadlines depend on the reason you qualify.
Examples include:
- You move. If you move outside your plan’s service area, or move somewhere with different plan options, you may qualify to change plans or return to Original Medicare. The enrollment window depends on the timing of your move and whether you notified your plan in advance.
- Your plan is ending or no longer serves your area. You may receive a special opportunity to select other coverage. Read the notice carefully because the applicable dates depend on the circumstances.
- You qualify under another special circumstance. Certain changes in other coverage, eligibility or exceptional situations may give you additional enrollment rights. Check with Medicare or your State Health Insurance Assistance Program (SHIP) rather than assuming you must wait until fall.
For many Special Enrollment Periods, the opportunity lasts two months, but this is not a universal deadline. Check the rules for your particular situation.
A separate protection applies to certain people in their first year of Medicare Advantage. If you joined a Medicare Advantage plan when you first became eligible for Medicare at age 65, you generally have a one-time opportunity during the first 12 months to leave the plan, return to Original Medicare and exercise applicable Medigap trial rights.
Similarly, if you dropped a Medigap policy to join Medicare Advantage for the first time, you may have a trial right to return to Original Medicare within the first 12 months and recover your previous Medigap policy if it is still available. Specific rules determine which policy you can buy and what happens if your previous policy is no longer sold.
These protections can be valuable, but they should not be confused with a general right to buy Medigap whenever you decide to leave Medicare Advantage.
Pay Close Attention
Your Medigap enrollment window does not restart
The federal Medigap Open Enrollment Period generally lasts six months, beginning when you are 65 or older and enrolled in Medicare Part B. During this period, you generally have the right to buy a Medigap policy without medical underwriting.
This is different from the Medicare Advantage enrollment periods in the fall and from January through March. Those periods allow eligible beneficiaries to change their Medicare coverage; they do not automatically restore Medigap guaranteed-issue rights.
After the initial six-month window, your ability to buy Medigap may depend on a qualifying guaranteed-issue right, state law and your individual circumstances.
Before leaving Medicare Advantage, verify your Medigap rights and options. See Medicare’s Medigap guidance information.
Before you switch, check two things separately: When can you change your Medicare coverage, and do you have the right to buy the Medigap policy you may want afterward?
The Medigap Trap: The Curve Ball in Medicare Advantage Plans
When you first choose how to receive your Medicare benefits, you generally have two main options: Original Medicare, with the option to buy a Medigap policy to help cover certain out-of-pocket costs, or a Medicare Advantage plan. You cannot use Medigap to supplement Medicare Advantage coverage.
Both approaches have advantages:
- With Original Medicare, you can generally see any doctor or other provider nationwide who accepts Medicare and is accepting new Medicare patients, subject to Medicare’s coverage rules. You can also buy Medigap, which helps pay certain costs that Original Medicare does not cover.
- Medicare Advantage plans, by contrast, may offer low or $0 plan premiums, bundled prescription drug coverage, an annual limit on covered Part A and Part B medical out-of-pocket costs, and additional bonus benefits.
Now for the curve ball: Leaving Medicare Advantage and returning to Original Medicare does not necessarily mean you can buy a Medigap policy.
This distinction matters because the ability to return to Original Medicare and the ability to obtain Medigap are two different things. If you return to Original Medicare without supplemental coverage, you may be responsible for deductibles, coinsurance and other costs that a Medigap policy might otherwise help pay.
If you develop more serious health problems after your initial Medigap enrollment window has closed, you may find that a Medigap insurer can deny your application or charge more, unless you qualify for a guaranteed-issue right or additional protections under state law. That can make returning to Original Medicare financially difficult.
This potential loss of access to Medigap is often called the “Medigap trap.” It is not inevitable, and it does not mean Medicare Advantage is the wrong choice for everyone. It means you should understand your options before making a change.
When Might You Be Able to Buy Medigap Without Medical Underwriting?
There are several important situations to understand.
- Your Medicare Advantage plan ends or you lose coverage under qualifying circumstances: If your plan terminates or you lose coverage in a situation covered by federal guaranteed-issue rules, you may have the right to buy certain Medigap policies without medical underwriting. The exact rights depend on why your coverage is ending and which rules apply.
In many of these situations, you can apply beginning 60 days before your Medicare Advantage coverage ends and no later than 63 days after it ends. Do not wait until the last minute: start checking your options as soon as you receive a termination or nonrenewal notice.
- You are voluntarily leaving Medicare Advantage after your initial Medigap enrollment window: This is where the trap can arise.
The federal Medigap Open Enrollment Period is generally a one-time, six-month period that begins when you are 65 or older and enrolled in Medicare Part B. During this period, insurers generally cannot deny you a Medigap policy or charge you more because of pre-existing health problems.
That six-month window does not restart every fall or every January–March enrollment period. If it has ended, federal law does not generally guarantee that you can buy any Medigap policy you want simply because you decide to return to Original Medicare.
You may still qualify for a different guaranteed-issue right or additional state protections. Otherwise, an insurer may be able to use medical underwriting, depending on the circumstances and state law.
- You qualify for a Medicare Advantage trial right: Special protections may apply if you joined Medicare Advantage when you first became eligible for Medicare at age 65 and decide to leave within the first 12 months. A trial right may also apply if you dropped a Medigap policy to join Medicare Advantage for the first time and leave within the first 12 months.
Depending on the circumstances, you may be able to buy certain Medigap policies without medical underwriting or recover the Medigap policy you previously had if it is still available. Do not assume that simply being enrolled in Medicare Advantage for a year—or for any other length of time—automatically gives you a Medigap guarantee.
If You Are Considering a Switch, Do It in This Order
- Find out whether you have a guaranteed-issue right. A SHIP counselor can help you understand your federal rights and check whether your state provides additional protections.
- Investigate Medigap before leaving Medicare Advantage. If you do not have a guaranteed-issue right and medical underwriting may apply, contact insurers and establish whether you can obtain coverage and what it will cost before you finalize the change.
- Arrange prescription drug coverage. If you return to Original Medicare and want Part D coverage, you generally need to enroll in a separate Medicare drug plan. Do not assume your Medicare Advantage prescription drug coverage automatically carries over.
- Coordinate your effective dates. Confirm when your Medicare Advantage coverage ends and when your Original Medicare, Medigap and Part D coverage will begin. You cannot use Medigap to supplement Medicare Advantage coverage.
The Bottom Line
Before leaving Medicare Advantage, ask not only whether you can switch, but also whether you can obtain the supplemental coverage you may want afterward. That extra step could make a substantial difference to your future health care costs.
For more information, read Medicare’s guide to buying a Medigap policy.
Important Restrictions to Keep in Mind
Remember these three golden rules:
- You cannot combine Medigap with Medicare Advantage. Medigap works exclusively with Original Medicare.
- Medigap policies do not include prescription drug coverage. If your Medicare Advantage plan included Part D prescription drug coverage (a MAPD plan), that coverage does not automatically become a stand-alone Part D plan when you return to Original Medicare. You generally must actively enroll in a separate Medicare Part D prescription drug plan if you want drug coverage.
- Do not cancel Medicare Advantage blindly. Before making a change, verify your enrollment rights, your Medigap eligibility, your state’s insurance rules and the effective dates of any replacement coverage. If medical underwriting may apply, find out whether you can obtain the supplement policy you want before finalizing your decision.
A little homework now can help you avoid expensive surprises later.
Continue the series: [Kayla: link to Hub article]
[Medicare Basic] · [Part A and Part B] · [Part D] · [Medigap] · [Medigap Plans: G, N, K, and L] · [Financial Assistance] · [Appeals]