How to Compare Medicare Advantage Plans

You’re probably wondering: “Will my doctor still take this plan? Will my medications cost more? Am I hunting for low cost only to get burned later?”
When you set out to compare Medicare Advantage plans, these questions are exactly what matter. It’s not about catchy ads or zero-premium hype—it’s about real fit. Some carriers change drugs, networks or costs each year even if the plan name doesn’t change.

Here’s how to stay ahead.

Start With Your Priorities: Providers, Drugs, Budget

When you’re ready to compare Medicare Advantage plans, begin with what you care about most—not the flashy marketing. Ask yourself: Will my doctor still accept this plan next year? Are my medications covered? And what’s my budget for unexpected care?
Your answers are the foundation. Without that clear, you’ll compare plans that look different but may cost you the same—or more—in the end.

Networks: HMO vs PPO, Referrals, Out-of-Network Rules

Let’s talk about the network rules—this is where you often see big differences when you compare Medicare Advantage plans.

• HMO (Health Maintenance Organization): Usually must use in-network providers, need PCP referrals for specialists, minimal or no out-of-network coverage.

• PPO (Preferred Provider Organization): More flexibility—can see out-of-network providers (at higher cost), often no referral required.
  When you compare Medicare Advantage plans, check:

• Are all your key doctors/hospitals in the network?

• Is out-of-network care allowed (if you travel or split homes)?

• Are referrals required (could be a hindrance if you see specialists)?

Pick a plan whose network rules match your lifestyle—flexibility costs more, restrictions may cost less but cost you peace of mind.

Drugs: Formularies, Tiers, Utilization Management

Your medications will often be the wild card in your cost—it’s critical when you compare Medicare Advantage plans.
Here’s what to check:

• Does the plan include your exact medications in its formulary (drug list)?

• What tier is each drug in? Lower tiers = lower cost. Higher tiers = higher cost.

• Are there utilization-management rules? Things like prior authorization or step therapy (you must try a cheaper drug first) can throw you for a loop.

When you compare Medicare Advantage plans, don’t just assume “it covers my drugs.” Confirm the tier, pharmacy rules, and any hurdles. A cheap plan with poor drug coverage will cost you in frustration or dollars.

Costs: Premiums, Copays, Coinsurance, MOOP

The monthly premium gets your attention—but when you compare Medicare Advantage plans, don’t stop there.

• Premiums: what you pay each month just to have the plan.

• Copays / Coinsurance: what you pay when you use the plan.

• Deductibles: if applicable.

• MOOP (Maximum Out-of-Pocket): how much you could pay in worst-case scenario.

When you compare Medicare Advantage plans side-by-side: calculate your expected cost (based on your usage) + your risk cost (if you use more care). A plan with a higher premium but lower worst-case may be better for you.

Care Rules: Prior Authorization and Care Pathways

Let’s get real: some plans bottle up “hidden costs” not with dollars, but with rules.
When you compare Medicare Advantage plans, check:

• Does this plan require prior authorization for common services (MRI, specialist visits)?

• Are there “care pathways” or referrals required? If your specialist takes five steps to approve a visit, you’ll feel that delay.

The easiest plan to use is the one that handles your care smoothly. When you compare Medicare Advantage plans, don’t just look at access, look at ease.

Extras: Dental, Vision, Hearing—What’s Actually Covered

Yes, those extras are nice. But when you compare Medicare Advantage plans: be clear about what’s included and what’s limited.

• Free dental check-ups may be great, but major procedures may be a separate cost.

• Vision benefit? Check what’s covered—glasses or only exam?

• Hearing perk? Does it cover aids or just testing?
  When comparing, keep these in a separate “bonus” column—they’re important, but only after your core providers, drugs and budget check out.

When a Medigap Path May Fit Better

There’s no “one-size-fits-all” when you compare Medicare Advantage plans—or when you compare Medicare Advantage vs Original Medicare + Supplement (Medigap).

Consider the Medigap path when:

• You use many specialists or hospitals and want wider provider access.

• You travel or live parts of the year away from home state and need flexible provider access.

• You dislike network-based restrictions or prior-authorization hassles.

When you compare Medicare Advantage plans (and the Medigap option), be clear: one path offers flexibility and predictable costs, the other offers networks and maybe lower premiums but more rules.

A Printable Comparison Worksheet (Criteria List)

Here’s a simple table to print or use in your own spreadsheet when you compare Medicare Advantage plans:

Print this, fill it in. You’ll see clearly which plan fits you best.

FAQs

What exactly is a Medicare Advantage plan?

A Medicare Advantage plan (also known as Part C) is an option from a private insurer that bundles your Medicare Parts A and B coverage (and usually Part D) under one plan. Because it’s a private plan, network rules, costs and drug coverage can differ significantly from Original Medicare. Medicare+1

If I have Original Medicare, can I switch to a Medicare Advantage plan?

Yes—if you’re eligible, you can switch to a Medicare Advantage plan during the Annual Enrollment Period or other valid enrollment window. But choosing one means you’ll need to compare how it fits your doctors, drugs and cost structure—plans are not identical.

What are the most important costs to compare in a Medicare Advantage plan?

Beyond the monthly premium, key costs include: deductibles, copays/coinsurance, and the plan’s annual maximum out-of-pocket (MOOP). Because you’ll use care in different ways than the “average,” comparing your likely usage is crucial to avoid surprises.

How do I know if my medications are covered by a plan?

When comparing Medicare Advantage plans, plug in your full drug list (name & dose) and preferred pharmacy, verify each drug’s tier, check if the pharmacy is in-network, and watch for utilization rules like prior authorization or step therapy. A plan that looks cheap but has bad drug fit may cost you much more later.

What happens if I enter a plan and later realise I dislike its network or rules?

Some enrollment windows allow changes if you realize your plan doesn’t fit—such as the Annual Enrollment Period. But waiting until you have a bad experience means you may be stuck in the wrong plan for months, with less flexibility and possibly higher costs.

How Brickhouse Guides an Apples-to-Apples Comparison

At Brickhouse, we help you compare Medicare Advantage plans by focusing on exactly what matters to you. Here’s how we do it:

• We start with your real use: doctors you see, medications you take, your travel or seasonal habits.

• We pull up multiple plans and walk you through side-by-side comparisons using the worksheet above.

• We emphasize networks, drug fit, budget risk, and ease of use—not just “premium looks low.”

• We help you compare Medigap paths when they might be a better fit.

• We keep things clear, no jargon, no pressure. You decide what’s right.

When you compare Medicare Advantage plans—or compare them against the Medigap track—having a partner who focuses on your fit makes all the difference.

Want help locking in your comparison or want us to walk the options side-by-side? Reach out and we’ll get you set up the right way.

Book a Plan Review with Brickhouse

Book a free check-in with us. We’ll walk through your needs, your current plan, and your options for next year—clear, no pressure, tailored to you.

Reach out via phone or click this link to schedule.

Let’s make sure your Medicare coverage is working for you—not against you.

Niki Feret is the founder of Brickhouse Agency, a boutique Medicare insurance agency licensed in 37 states. As one of the few female agency owners in the industry, Niki leads with clarity, compassion, and a commitment to education – not pressure. Learn more or book your free Medicare consultation at BrickhouseAgency.com.