How to Shop Medicare Advantage Plans: 5 Key Benchmarks
Choosing the Right Medicare Advantage Plan
Shopping for a Medicare Advantage (Part C) plan can feel overwhelming—but it doesn’t have to be. Every plan offers a unique mix of costs, benefits, and provider access, so understanding what matters most to you is key. Below are five benchmarks to help guide your decision and ensure you find the right plan for your needs.
1. Network
Your healthcare provider network is one of the most important factors when choosing a Medicare Advantage plan. Make a list of your preferred doctors, specialists, and hospitals, then check which plans include them. If you travel frequently or split your time between states, look for plans that provide broad network access or national coverage. The more flexibility you have with providers, the easier it is to get care where and when you need it.
2. Prescription Drug Coverage (Rx)
Prescription costs can vary dramatically between plans—even within the same area. Review your list of current medications and compare how each plan covers them. Check the formulary (list of covered drugs), and don’t forget to factor in preferred pharmacy pricing or mail-order options. If you take expensive medications, talk with your doctor about generic alternatives or prescription savings coupons to keep costs manageable.
3. Maximum Out-of-Pocket (MOOP)
The MOOP is the most you’ll pay out of pocket for hospital and medical services in a plan year. Once you reach this limit, the plan pays 100% for covered services for the rest of the year. Plans with lower MOOPs can protect you from unexpected high medical bills. Remember, this amount doesn’t include your monthly premiums or prescription copays—so factor those in separately.
4. Overall Benefit
Think of this benchmark as your best case vs. worst case scenario.
A plan offering dental, vision, and over-the-counter (OTC) benefits may look great on paper—but weigh those perks against potential costs like copays and the MOOP.
For example:
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Best case: $1,500 dental + $200 eyewear + $100 OTC = $1,700 in added value.
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Worst case: $20 monthly premium + $5,500 MOOP = $5,740 in potential costs.
Knowing both ends of the range helps you plan your healthcare budget more realistically.
5. Personal Specifications
Your personal lifestyle and health needs should always guide your plan choice. Do you live part of the year in another state? Need access to specific specialists? Or prefer a plan with strong telehealth benefits? Personal factors—like travel habits, seasonal living, or chronic health conditions—can outweigh other considerations.
The Bottom Line
There’s no one-size-fits-all Medicare Advantage plan. The best plan for you depends on your network, prescription needs, out-of-pocket protection, benefits, and lifestyle.
Working with a local, licensed Medicare agent—like Medicare Planning—can help you compare options from multiple carriers, verify provider participation, and find a plan that fits both your health and budget.