A Medicare Plan Comparison Checklist to Use Before December 7

Step 1: Decide What You Are Actually Comparing

Before you open any website, be clear on the question. There are really two kinds of comparison, and mixing them up is the most common reason people get stuck.

The first is a comparison within a type of coverage. If you have a Medicare Advantage plan and you like the idea of staying in one, you are comparing your current plan against other Medicare Advantage plans in your county. If you have Original Medicare and a standalone Part D plan, you are comparing drug plans.

The second is a comparison between types of coverage: Original Medicare with a Medigap policy versus Medicare Advantage. That one is a larger decision, and it comes with a catch worth knowing early. Medigap is not part of the fall enrollment window. In most states, an insurer can ask health questions when you apply for a Medigap policy outside your six-month Medigap open enrollment period or another guaranteed-issue situation. If you are on Medicare Advantage today and are thinking about leaving it, find out whether you could get a Medigap policy before you cancel anything. Our page on the Medigap open enrollment period explains the timing.

Write down which of the two you are doing. Everything below is easier once you do.

Step 2: Gather Your Own Information First

Most people start with a plan and then search for their facts. Do it the other way around. Collect these before you compare anything:

• Your Medicare card, so you have your Medicare number handy for Plan Finder.
• Your current plan’s Annual Notice of Change, and the Evidence of Coverage if it has arrived. Our guide to reading your Annual Notice of Change covers how to go through them.
• A complete list of your prescriptions, with the dose and how often you take each. Include medications you take only now and then, and any you receive by mail order.
• The names and office locations of your doctors, specialists, and the hospital you would go to.
• Your preferred pharmacy, and a second one you would be willing to use.
• A rough picture of how you used care this year: number of specialist visits, any hospital stays, emergency visits, tests, physical therapy.

That last item is the one people skip, and it matters. A plan is cheap or expensive only in relation to how you use it. Last year’s usage is not a prediction, but it is a better starting point than a guess.

Step 3: Check Every Drug, Dose, and Pharmacy

Drugs are the first filter, because they are where a plan can be a poor fit in a way you cannot fix mid-year. Enter your drug list into the Medicare Plan Finder at Medicare.gov, with the exact dose and form, and choose your pharmacy. The tool will show which plans cover each drug and estimate what you would pay.

For each plan that makes your short list, look at four things for every medication:

• Is it on the formulary?
• Which tier is it on?
• Does the plan require prior authorization, step therapy, or quantity limits?
• What is the cost at your preferred pharmacy versus another one?

If a drug you take is not covered, or has restrictions, that does not automatically eliminate the plan. But you should know about it, and you should ask your prescriber whether a covered alternative would work for you. Never switch or stop a medication on your own because of a plan comparison. That is a decision for you and your prescriber.

Part D plans also have a yearly cap on what you pay out of pocket for covered drugs, and that cap is adjusted over time. Because the exact figure changes, check the amount shown on Medicare.gov for the coming year rather than relying on a number you saw elsewhere.

Step 4: Confirm Your Doctors and Hospitals Are In Network

If you are comparing Medicare Advantage plans, networks matter. Original Medicare works with any provider who accepts Medicare. Most Medicare Advantage plans work through networks, and going outside the network can cost more or, in an HMO, may not be covered except for emergencies.

Check each of your key providers in the plan’s online directory, and then confirm by phone with the doctor’s office. Give them the full plan name and ask whether they are in network for that plan this year, at your specific location. A doctor who “takes Medicare” is not necessarily in the network of a particular Medicare Advantage plan. Directories can be out of date, and the office tends to have the most current picture of its contracts.

Also check the hospital you would want to use, and the specialists connected to it. Hospital-based doctors, such as anesthesiologists or radiologists, may bill separately, so ask whether the hospital’s contracts cover them as well. For more on how HMO and PPO structures differ here, see our guides to HMO plans and PPO plans.

Step 5: Add Up the Cost of a Typical Year

Cost piece	What to count	Where to find it
Premiums	Twelve months of plan premium, plus your Part B premium	Plan Finder, plan notice
Deductibles and copays	Based on how you used care this year	Evidence of Coverage
Drug costs	Your actual drug list at your pharmacy	Plan Finder estimate
Worst-case year	The plan’s out-of-pocket limit	Plan documents

Premium is one number. Total cost is a different one. For each plan, estimate your annual cost as the sum of three things:

• The premiums you would pay across twelve months, plus your Part B premium, which most people keep paying with Medicare Advantage.
• The deductibles and copays you would likely pay, based on how you used care this year.
• Your drug costs, which Plan Finder estimates based on the list you entered.

This will not be exact, and it does not need to be. The purpose is to see whether a plan with a low premium and high copays comes out ahead of one with a higher premium and lower copays, given how you use care. If you are in generally good health and rarely see a doctor, a low-premium plan can come out ahead. If you see specialists often or have a regular treatment, copays can add up quickly.

Be wary of comparing premiums alone. A zero-dollar premium is common in Medicare Advantage, but it does not mean zero cost. It means you pay no plan premium; you still pay your Part B premium and any cost-sharing when you get care.

Step 6: Study the Worst Case

The next question is the one most people avoid: what happens if you have a bad year? A hospital stay, a surgery, or a serious diagnosis can turn a modest-cost plan into an expensive one.

Medicare Advantage plans have a yearly limit on what you pay for covered Part A and Part B services, and it is set by federal rules. Most plans offer a limit below the federal maximum. AARP notes that the limit does not include premiums, and it does not apply to Part D drugs, which have their own cap. PPO plans also have a separate, higher combined limit that includes out-of-network care, and the limit generally does not count supplemental benefits such as dental or vision. Original Medicare has no out-of-pocket limit at all, which is why many people who use it add a Medigap policy.

For each plan, write down the maximum out-of-pocket amount, and note whether it applies to in-network care only. Then ask yourself: could I handle that amount in a single year? Our overview of Medicare costs and the guide to what a major health event can cost give more context for that question.

Step 7: Read the Rules That Control Access

Costs are what you see. Rules are what you run into. Look at how each plan handles the following, using the Evidence of Coverage and the plan’s website:

• Referrals. Some plans require a referral from your primary doctor to see a specialist.
• Prior authorization. Most Medicare Advantage plans use it for some services, such as hospital stays, skilled nursing care, and drugs given by a provider (Part B drugs). Ask which services on your radar require it.
• Out-of-area coverage. If you travel or spend part of the year somewhere else, find out what the plan covers away from home.
• Urgent and emergency care. All plans must cover emergencies, but the rules for urgent care vary.

These are not reasons to rule a plan out. They are things to know so a plan does not surprise you in March.

Step 8: Check the Extras, but Do Not Let Them Drive the Decision

Dental, vision, hearing, over-the-counter allowances, fitness memberships, and similar extras are popular selling points. They are real benefits, but they are also where plans tend to impose yearly limits, waiting periods, or a specific vendor you must use.

Ask what the benefit actually pays. A plan that advertises a dental benefit might cover cleanings but pay only a small amount toward crowns. If you already know you need a particular service, price it. If you do not, treat the extras as a tiebreaker rather than a reason to choose a plan whose medical coverage is a poorer fit.

Step 9: Look at Star Ratings, With Realistic Expectations

Medicare rates Medicare Advantage and Part D plans on a five-star scale, and you will see those ratings in Plan Finder. They are a reasonable quick check on member experience, customer service, and how a plan manages care. NCOA describes them as one input to weigh alongside premiums, deductibles, networks, prescription drug coverage, and out-of-pocket costs, not as the sole factor. If you are thinking of using the five-star Special Enrollment Period to switch, NCOA also cautions that moving from a plan with drug coverage to one without it could cost you your Part D coverage. A highly rated plan can still leave out your doctor, and a plan without a high rating can still suit your situation. Use the rating as a flag, not a verdict.

Step 10: Make the Choice, and Document It

Once you have narrowed to one or two plans, ask yourself a final set of questions. Do my drugs work? Are my doctors in? Can I afford the worst case? Do I understand the rules? If the answers are yes, you have what you need.

Then enroll with room to spare before December 7. Medicare.gov says the plan has to receive your request by that date. Keep the confirmation number. In late December, watch for your new member card and welcome packet, and check that your pharmacy and doctors have your new plan information before your first appointment in January. If you decide to stay in your current plan, you generally do nothing at all. For a refresher on the dates, see our guide to the Annual Enrollment Period.

If a step on this list feels too big to do alone, you are not stuck. The Ohio Senior Health Insurance Information Program, OSHIIP, offers free, unbiased one-on-one help to Ohioans on Medicare, and independent agents can compare plans in your county at no direct cost to you.

Frequently Asked Questions

What is the most important thing to check when comparing Medicare plans?

Your prescriptions and your doctors. A plan that does not cover your medications or does not include your doctors is a poor fit regardless of its premium or extras.

How do I compare Medicare Advantage plans?

Use the Medicare Plan Finder with your zip code, your drug list, and your pharmacy, then check each plan’s network, total estimated cost, and out-of-pocket limit. Confirm your doctors in the plan’s directory and with their offices.

Does a lower premium mean a better plan?

Not necessarily. Premium is only one part of your total cost. Deductibles, copays, drug costs, and the out-of-pocket limit can matter more depending on how you use care.

Can I compare Medigap plans during open enrollment?

You can look at them at any time, but Medigap is not part of the fall enrollment window, and in most states you may have to answer health questions to qualify. Check your options before leaving a plan you have.

Do I need to compare plans every year?

Plans change their costs, drug lists, and networks every year, so a yearly look is a good habit. If nothing changed that affects you, staying put is a perfectly good result.