Medicare Plan Comparison: What to Look For and What to Avoid
Choosing a Medicare plan is one of the most important healthcare decisions you’ll make as you approach age 65 or become eligible due to a disability. With so many options available—Original Medicare, Medicare Advantage, Medigap, Part D—it’s easy to feel overwhelmed. But understanding your needs and knowing what to watch for can make all the difference. That's why we've put together this Medicare plan comparison.
Read through our helpful guide and learn about what you should look for and what you should avoid when selecting a Medicare plan.
What to Look For in a Medicare Plan
1. Coverage That Matches Your Health Needs
The first step is understanding what type of coverage you need. Original Medicare (Parts A and B) covers hospital and medical services, but it doesn’t cover things like prescription drugs, dental, vision or hearing. If you take medications regularly or have ongoing health conditions, you may want to consider adding a Part D plan (prescription drug coverage) or enrolling in a Medicare Advantage plan that bundles extra benefits.
Think about the doctors you see, the prescriptions you take and whether you need frequent specialist visits. A good Medicare plan should align with your current and expected health needs.
2. Access to Preferred Doctors and Hospitals
If you have a doctor or healthcare provider you like, make sure they accept the Medicare plan you're considering. With Original Medicare, you can typically see any provider that accepts Medicare nationwide. With Medicare Advantage (Part C), you’ll likely need to stay within a network of providers.
Check that your preferred doctors, hospitals and specialists are in-network before enrolling. This step can help you avoid unwanted surprises down the road.
3. Prescription Drug Coverage (if needed)
If you take prescription medications, you’ll need either a stand-alone Part D plan (for those with Original Medicare) or a Medicare Advantage plan that includes drug coverage. Not all plans cover the same medications, and drug costs can vary widely.
Review each plan’s formulary (the list of covered drugs) to ensure your prescriptions are included. Also pay attention to things like co-pays, deductibles and whether your pharmacy is in-network.
4. Reasonable Out-of-Pocket Costs
Look at the full picture—not just the monthly premium. Consider deductibles, copayments, coinsurance and out-of-pocket maximums. Medicare Advantage plans are required to set an annual out-of-pocket limit, which can be a safety net if you face high medical costs.
If you expect to use a lot of healthcare services, a plan with slightly higher premiums but lower out-of-pocket costs might save you money in the long run.
5. Additional Benefits You’ll Use
Many Medicare Advantage plans offer extra benefits not covered by Original Medicare, like dental, vision, hearing aids, transportation, fitness programs and even over-the-counter product allowances. These benefits can be valuable, but only if they align with your needs.
Be careful not to choose a plan just because it sounds loaded with extras. Focus on benefits you’ll actually use and that improve your quality of life.
What to Avoid When Choosing a Medicare Plan
1. Choosing Based Only on the Monthly Premium
It can be tempting to pick the plan with the lowest premium, but cheaper isn't always better. Low-cost plans often have higher deductibles, fewer provider options or limited coverage for services and medications.
Make sure to evaluate the total cost of the plan, including how much you’d pay out of pocket when you actually use healthcare services.
2. Ignoring the Provider Network
If you choose a Medicare Advantage plan, don’t assume your current doctors and hospitals are covered. These plans often have limited networks, and going out-of-network can lead to much higher costs—or no coverage at all.
Always confirm that your preferred providers and pharmacies are in-network before enrolling in a plan.
3. Overlooking the Fine Print
Each plan has its own rules, restrictions and coverage details. It’s important to read the plan documents carefully, especially the Summary of Benefits and Evidence of Coverage.
Look for hidden costs like prior authorization requirements, referral rules for specialists or limitations on certain services. If something seems unclear, don’t hesitate to call the plan and ask questions.
4. Missing Enrollment Deadlines
Timing matters when it comes to Medicare. If you miss your Initial Enrollment Period (around your 65th birthday), you may face penalties or have fewer plan choices later. You can also review and change your plan each year during the Open Enrollment Period (October 15 to December 7).
Stay on top of deadlines to avoid unnecessary costs or coverage gaps.
Final Thoughts
Choosing a Medicare plan doesn't have to be stressful if you focus on your personal needs, ask the right questions and take your time. Look for plans that give you access to the doctors and services you trust, cover your prescriptions and protect you financially. At the same time, avoid making choices based solely on low premiums or flashy extras.
A little planning goes a long way—so take the time to compare your options and find the plan that fits your health, lifestyle, and budget.