Key Questions Before Choosing a Medicare Advantage Plan: Checklist

Overview

Medicare Advantage plans are a popular option for millions of seniors, offering bundled coverage that often goes beyond Original Medicare. But with so many choices during the Medicare Annual Enrollment Period, picking the right plan can feel overwhelming. That’s where a Medicare Advantage checklist comes in.

This guide walks you through the key questions to ask a Medicare plan before signing up, helping you compare benefits, deductibles, and out-of-pocket costs, and networks so you can confidently choose the best Medicare Advantage plan in 2025.

Understanding Medicare Advantage

Medicare Advantage (Part C) plans are offered by private insurers approved by Medicare. Instead of using Original Medicare (Parts A and B) directly, you’ll receive your benefits through the Medicare Advantage plan.

These plans often include extras like prescription drug coverage, dental, vision, or fitness benefits. But each plan has different rules, provider networks, and costs—making comparisons essential.

A Medicare Advantage comparison checklist ensures you’re weighing what matters most to your health and budget.

Key Questions to Ask Before Choosing a Plan

1. Are My Doctors and Hospitals In-Network?

• Confirm your primary care doctor and specialists are covered.

• Check if your preferred hospital is included.

• Ask about referrals or approvals needed to see specialists.

Why it matters: Out-of-network care can be expensive or not covered at all.

2. What Will I Pay Out-of-Pocket?

• Monthly premium (in addition to your Part B premium)

• Deductibles, copays, and coinsurance amounts

• Maximum out-of-pocket limit

Tip: Compare not just the premium, but also what you might pay in a high-use year.

3. Does the Plan Include Prescription Drug Coverage?

• Are your medications on the plan’s formulary (list of covered drugs)?

• What are the copay tiers for generics vs. brand-name drugs?

• Which pharmacies are preferred in-network?

Example: Some plans offer $0 copays for mail-order generics.

4. What Extra Benefits Are Included?

• Dental, vision, and hearing care

• Fitness memberships (like SilverSneakers®)

• Over-the-counter (OTC) allowances

• Transportation to medical appointments

These perks can add value—but only if you’ll use them.

5. Are There Geographic or Travel Restrictions?

• Does the plan cover you when you travel out of state?

• What happens if you spend part of the year in another location (snowbirds)?

Some PPOs offer more flexibility than HMOs for travelers.

Learn more about Medicare plans in each state.

6. How Has the Plan Performed?

• Check the CMS star rating (1 to 5 stars)

• Look for member satisfaction scores and quality of care indicators

A higher rating often reflects better customer service and health outcomes.

Common FAQs About Medicare Advantage Plans

Q: Is Medicare Advantage better than Original Medicare?
A: It depends on your needs. Advantage plans offer bundled benefits but may limit provider choice.

Q: Can I switch plans later?
A: Yes. The Annual Enrollment Period (Oct. 15–Dec. 7) allows you to change plans each year.

Q: What’s the difference between HMO and PPO Medicare Advantage plans?
A: HMOs usually require referrals and in-network care, while PPOs offer more flexibility—often at higher costs.

Medicare Advantage Comparison Checklist

Before enrolling, ask yourself:

• Are my doctors and hospitals in-network?

• What are the premiums, deductibles, and out-of-pocket max?

• Is my medication list covered affordably?

• Do I need dental, vision, or hearing benefits?

• Will the plan work if I travel or live in two states?

• How strong is the plan’s star rating and reputation?

The Bottom Line

Choosing the best Medicare Advantage plan in 2025 isn’t about finding the cheapest option—it’s about finding the right fit for your health needs, lifestyle, and budget. By following this Medicare Advantage checklist, you’ll be better prepared to compare plans, ask the right questions, and make a confident decision during enrollment.

Ready to take the next step? Review your local plan options online, or speak with a licensed Medicare advisor for one-on-one guidance.