Choosing a Medicare Advantage Plan That's Right for You

Health Line

5 hours ago

There are many factors to consider when choosing a Medicare Advantage (Part C) plan, including costs, in-network providers, and coverage for medical services and prescription medications.
If you're shopping for a Medicare Advantage (Part C) plan this year, you may wonder what the best plan is for you. It depends on your personal situation, medical needs, how much you can afford, and other factors.
Tools are available to help you find Medicare Advantage plans in your area that can meet all your healthcare needs.
Glossary of common Medicare terms
Out-of-pocket cost: This is the amount you pay for care when Medicare doesn't pay the full cost or offer coverage. It includes premiums, deductibles, coinsurance, and copayments.
Premium: This is the monthly amount you pay for Medicare coverage.
Deductible: This is the annual amount you must spend out of pocket before Medicare begins to cover services and treatments.
Coinsurance: This is the percentage of treatment costs you're responsible for paying out of pocket. With Medicare Part B, you typically pay 20%.
Copayment: This is a fixed dollar amount you pay when receiving certain treatments or services. With Medicare, this often applies to prescription medications.
Factors to consider when choosing a Medicare Advantage plan
With all the changes being made to the Medicare plans on the market, it can be hard to narrow down the best plan for you.
Here are a few things to look for in a Medicare Advantage plan:
costs that fit your budget and needs
a list of in-network providers that includes any doctor(s) you would like to keep
coverage for services and medications you know you'll need
Centers for Medicare & Medicaid Services (CMS) star rating
Research CMS star ratings
The CMS has implemented a 5-star rating system to measure the quality of health and drug services provided by Medicare Advantage and Medicare Part D (prescription drug) plans.
Every year, the CMS releases these star ratings and additional data to the public.
The CMS ratings can be a great place to start when shopping around for the best Medicare Advantage plan in your state. Consider researching these plans for more information on what coverage is included and how much it costs.
To see all available Medicare Part C and D 2025 star ratings, visit CMS.gov and download the 2025 Medicare Star Ratings Data Table.
Consider your coverage priorities
All Medicare Advantage plans cover what Original Medicare covers — this includes hospital coverage (Part A) and medical coverage (Part B).
When you choose a Medicare Advantage plan, you first want to consider what type of coverage you need in addition to the coverage above.
Most Medicare Advantage plans offer one, if not all, of these additional types of coverage:
prescription drug coverage
dental coverage, including yearly exams and procedures
vision coverage, including yearly exams and vision devices
hearing coverage, including exams and hearing devices
fitness memberships
medical transportation
additional healthcare perks
Finding the best Medicare Advantage plan means making a checklist of the services you want to receive coverage for. You can then take your coverage checklist to Medicare's find a plan tool and compare plans that cover what you need.
If you find a plan that looks good for you, don't be afraid to call the company to ask if they offer any additional coverage or perks.
Determine your budget and potential healthcare costs
One of the most important things to consider when choosing the best Medicare Advantage plan is how much it will cost you. The find a plan tool lists the following cost information with the plans:
monthly premium
Part B premium
in-network yearly deductible
drug deductible
in- and out-of-network out-of-pocket max
copays and coinsurance
To get a starting estimate of your yearly costs, consider the premium, deductible, and out-of-pocket max. Any deductible listed is the amount you'll owe out of pocket before your insurance begins to pay out. Any out-of-pocket max listed is the maximum amount you will pay for the services throughout the year.
When estimating your plan costs, consider these costs plus how often you will need to refill prescription drugs or make office visits.
If you require specialist or out-of-network visits, include those potential costs in your estimate as well. Remember that your amount may be lower if you receive financial assistance from the state.
Review other benefits you may already have
If you already receive other types of healthcare benefits, this may factor into what kind of Medicare Advantage plan you'll need.
For example, if you already receive Original Medicare and have opted to add Part D or Medigap, many of your needs may already be covered.
However, you can always do a coverage comparison to determine whether a Medicare Advantage plan would work better or be more cost-effective for you.
What Medicare Advantage plans are available?
When beginning your search for a Medicare Advantage (Part C) plan, it's important to know the differences between each type of plan.
You'll probably see some or all of the following types of plans when reviewing your options:
Health Maintenance Organization (HMO) plans: HMO plans are primarily focused on in-network healthcare services.
Preferred Provider Organization (PPO) plans: PPO plans charge different rates depending on whether the services are in or out of network. (A 'network' is a group of providers who contract to provide services for the specific insurance company and plan.) PPO plans may provide more options to receive out-of-network care.
Private Fee-for-Service (PFFS) plans: PFFS plans let you receive care from any Medicare-approved provider who will accept the approved fee from your plan.
Special Needs Plans (SNPs): SNPs offer additional help for medical costs associated with specific chronic health conditions.
Medicare Savings Account (MSA) plans: MSA plans combine a high-deductible health plan with a medical savings account.
Each plan offers options to accommodate your healthcare needs.
For example, if you have chronic health conditions, SNPs are designed to help alleviate some long-term costs. On the other hand, a PFFS or MSA plan might be beneficial if you travel and need to see out-of-network healthcare professionals.
When do you sign up for a Medicare Advantage plan?
The Medicare enrollment process can begin as early as 3 months before you or your loved one turns 65 years old. This is the best time to apply, as it will ensure that you receive coverage by your 65th birthday.
You can wait to apply for Medicare until the month of your 65th birthday or the 3 months following your birthday. However, coverage can be delayed if you wait, so try to apply early.
If you decide not to enroll in a Medicare Advantage plan when you first turn age 65, you have another chance during Medicare's annual open enrollment period.
From October 15 through December 7 each year, you can switch from Original Medicare to Medicare Advantage. You can also switch from one Medicare Advantage plan to another or add, remove, or change a Part D plan.
The takeaway
There are many factors that can influence which Medicare Advantage plan you choose. Consider the CMS star rating, your priorities and healthcare needs, how much you can afford, and what type of insurance you currently have.
It's important to enroll in Medicare before you turn age 65 to ensure that you don't go without medical coverage. Don't forget that you have the power to shop around for the best Medicare Advantage plan that fits all your needs.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.