Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. They provide all Part A and Part B benefits, and most include Part D drug coverage (MAPD plans).
35 steps across 8 sections
1. Confirm Your Eligibility
- Must be enrolled in Medicare Parts A and B
- Must live in the plan's service area
- Cannot have End-Stage Renal Disease (ESRD) in most cases (exception: some plans now accept ESRD under recent rules)
2. Gather Your Current Information
- List all current doctors, specialists, and hospitals
- List all prescription medications with dosages
- Note any upcoming procedures or treatments
- Review your current healthcare spending patterns
3. Compare Plan Networks
- Verify your preferred doctors and hospitals are in-network
- Check network type: HMO (need referrals, in-network only), PPO (out-of-network allowed at higher cost), PFFS
- Ask specifically if your specialists participate in the plan
- Confirm your preferred pharmacy is in the plan's network
4. Evaluate Total Costs
- Monthly premium Many MA plans have $0 premium (on top of the $202.90 Part B premium you still pay)
- Annual deductible Varies by plan
- Copays/coinsurance Per-visit costs for doctors, specialists, hospital stays
- Out-of-pocket maximum CMS cap is $9,250 in-network for 2026 — compare plans' actual maximums
- Drug costs Review the plan's formulary tiers and drug copays
5. Check Prescription Drug Coverage
- Enter your medications into Medicare Plan Finder to compare drug costs
- Review the plan's formulary (list of covered drugs)
- Check for prior authorization, step therapy, or quantity limits on your medications
- Note the standard Part D deductible ($615 in 2026) — some MA plans waive it
6. Review Extra Benefits
- Dental coverage (preventive and/or comprehensive)
- Vision (exams and eyewear allowances)
- Hearing (exams and hearing aid benefits)
- Fitness programs (SilverSneakers, gym memberships)
- Over-the-counter (OTC) benefit allowances
- Transportation to medical appointments
- Read the Evidence of Coverage (EOC) for exact benefit details and limits
7. Check Quality Star Ratings
- CMS rates every MA plan on a 1-to-5 star scale
- Ratings cover quality of care, chronic condition management, member satisfaction
- 4+ star plans may offer extra benefits and lower costs
- View ratings at medicare.gov/plan-compare
8. Enroll in Your Chosen Plan
- Online Through the plan's website or medicare.gov
- Phone Call the plan directly or 1-800-MEDICARE
- In person Through a licensed insurance agent
- Enrollment periods: IEP, Annual Open Enrollment (Oct 15-Dec 7), MA Open Enrollment (Jan 1-Mar 31)
Common Mistakes
- Choosing solely based on $0 premium
- Not verifying doctor participation
- Ignoring the out-of-pocket maximum
- Not checking drug formulary
- Not reviewing the Annual Notice of Change
Pro Tips
- Use Medicare Plan Finder (medicare.gov/plan-compare) to compare all plans in ...
- Call potential plans and ask specific questions about your doctors, drugs, an...
- Consider a PPO if you travel frequently or see out-of-area specialists
- Look at the plan's star rating history, not just the current year
- Get free help from SHIP counselors (State Health Insurance Assistance Program)