Medicare Advantage Plan Comparison Guide for Open Enrollment

Medicare open enrollment allows you to switch plans from Oct. 15 to Dec. 7, with changes taking effect on Jan. 1. To choose the right Medicare Advantage plan, you must compare provider networks, prescription drug formularies, and total out-of-pocket costs rather than just looking at monthly premiums. This guide provides a step-by-step method for analyzing plan details and using CMS resources to make an informed decision.

When Does Medicare Open Enrollment Occur?

The annual window for changing your Medicare Advantage (MA) or Original Medicare coverage is strictly defined by the Centers for Medicare & Medicaid Services (CMS). For the 2027 plan year, this period begins on Oct. 15, 2026, and ends on Dec. 7, 2026. Any changes you make during these two months will apply to your coverage starting in January. If you miss this deadline, you generally must wait until the next year's open enrollment or qualify for a special enrollment period due to a life change.

What Is a Medicare Advantage Plan?

Medicare Advantage, also known as Part C, is offered by private insurance companies approved by the federal government. These plans bundle your hospital coverage (Part A) and doctor visits (Part B) into one package. Many plans also include prescription drug coverage (Part D). Unlike Original Medicare, which allows you to see any provider that accepts Medicare, MA plans often require you to stay within a specific network of doctors and hospitals. Understanding this distinction is the first step in your comparison process.

What Are the Main Types of MA Plans?

Not all MA plans work the same way. The structure of the plan dictates how you access care. The most common types include:

• HMOs: These Health Maintenance Organization plans usually require you to use in-network providers and often need a referral to see a specialist. They typically offer lower monthly costs.
• PPOs: Preferred Provider Organization plans offer more flexibility. You can usually see out-of-network doctors for a higher cost and generally do not need referrals for specialists.
• PFFS: Private Fee-for-Service plans allow you to visit any Medicare-approved doctor who accepts the plan’s terms. Providers may negotiate payment terms directly with the plan.
• SNPs: Special Needs Plans are designed for people with specific chronic conditions or disabilities, providing coordinated care.

How Do You Compare Provider Networks?

The network is the core of your MA plan. If your preferred primary care physician or specialists are not in the network, you will likely pay higher costs or need permission to see them. Start by listing your current doctors and hospitals. Then, check the provider directory for each plan you are considering. Many large carriers, such as UnitedHealthcare and Humana, have extensive networks, but local availability can vary. Always verify that the doctors you rely on are in-network. For HMOs, also confirm if they require referrals for specialist visits.

How Do You Evaluate Prescription Drug Coverage?

Most Medicare Advantage plans include drug coverage. However, the list of covered drugs, known as the formulary, changes every year. A drug that is covered in your current plan might move to a higher tier or be excluded in a new plan. To compare drug coverage, pull up your last six months of pharmacy bills. Check if your medications are on the proposed plan’s formulary. Look at the cost tiers for each drug. Some plans may have lower copays for one medication but higher copays for another. Also, check if the plan requires you to fill prescriptions only at specific pharmacy chains to save money.

What Is the True Total Cost of a Plan?

A plan with a $0 monthly premium is not necessarily the cheapest option. You must calculate the total out-of-pocket costs, which include deductibles, copayments, and coinsurance. The annual out-of-pocket maximum is a critical figure. This is the most you will pay in a year for covered services. Once you hit this limit, the plan pays 100 percent of covered costs. Compare this maximum across plans. A plan with a lower premium but a very high out-of-pocket maximum might cost more if you have frequent medical needs. According to CMS, the national out-of-pocket maximum for all covered benefits in 2026 is $8,550. Many individual plans have a lower maximum, often between $5,000 and $6,000, which offers better financial protection.

How Do You Use Star Ratings?

CMS rates every Medicare Advantage plan on a scale of one to five stars based on quality of care and member experience. You can find these ratings on the official Medicare website. A rating of four stars or higher indicates a plan that performs better than the national average. Look specifically at the star ratings for member experience and quality of care. High star ratings often correlate with better customer service and lower complaint rates. Use the Plan Finder tool on Medicare.gov to sort plans by star rating and filter them by your specific needs.

What Extra Benefits Should You Look For?

Medicare Advantage plans can offer benefits that Original Medicare does not cover. These extras can add significant value. Common benefits include:

• Dental and Vision: Many plans offer annual allowances or discounts for glasses, contacts, and routine dental work.
• Hearing: Some plans cover hearing aids or testing.
• Wellness: Benefits may include gym memberships, transportation to medical appointments, or over-the-counter health product allowances.

Do not choose a plan solely for extra perks if the core medical and drug coverage is poor. However, if two plans have similar costs and networks, the extra benefits can help break the tie.

How Do You Make the Final Decision?

Once you have compared networks, drug costs, out-of-pocket limits, and star ratings, you can make your choice. Use the Medicare Plan Finder to finalize your selection. You can also contact plan representatives directly to ask specific questions about your needs. Remember that you can switch plans during the annual open enrollment period. Take your time to review the Summary of Benefits for each plan. This document outlines exactly what is covered and what you will pay.

Frequently Asked Questions

What happens if I miss the open enrollment deadline?

If you do not change your plan during the annual window, your current coverage will remain in effect for the next year. You generally cannot switch to a new plan until the following Oct. 15, unless you qualify for a Special Enrollment Period due to a move, loss of other coverage, or other specific life events.

Are $0 premium Medicare Advantage plans always the best value?

Not necessarily. A $0 premium plan may have higher deductibles, higher copays, or a higher out-of-pocket maximum. You must evaluate the total cost of care, not just the monthly premium. A plan with a small premium but a low out-of-pocket maximum might save you more money in the long run if you use healthcare services frequently.

Can I keep my current doctors with any Medicare Advantage plan?

You cannot keep your doctors with every plan. Medicare Advantage plans have specific networks. You must check the provider directory for each plan to ensure your current doctors are in-network. If they are not, you will either need to switch doctors or choose a different plan.

What is the difference between Medicare Advantage and Original Medicare?

Original Medicare is the traditional government program that allows you to see any provider that accepts Medicare. It does not include drug coverage. Medicare Advantage is offered by private insurers, bundles hospital and medical coverage, usually includes drug coverage, and often requires you to stay within a specific network of providers.

How often do Medicare Advantage plans change their benefits?

Medicare Advantage plans can update their benefits, premiums, and network rules every year. This is why it is important to review your options during open enrollment. A plan that was the best fit for you in 2026 may not be the best fit in 2027 due to changes in costs or coverage details.