How to Compare Medicare Advantage Plans in 2026 - Checklist

Medicare Advantage, at a Glance

Medicare Advantage (Part C) plans come from Medicare-approved private insurers. Most roll hospital (A) and medical (B) together and often add drug coverage (D). Many plans layer on wellness perks—think dental, vision, hearing, OTC, and fitness. Because most plans use networks, provider participation is a top comparison point.

What to Compare First (2026)

• Your medications: Are all drugs on the formulary? What tiers and pharmacy rules apply?

• Your providers: Are your doctors/hospitals in network next year?

• Your usage pattern: Estimate annual total cost (premium + copays/coinsurance up to the OOP max).

• Extras you’ll use: Dental/vision/hearing, OTC allowance, fitness, transportation.

Online comparison tools can speed this up—filter by medication, doctors, and pharmacies to see true year-ahead costs.

Provider Networks & Access

• In-network = lower costs. Out-of-network visits (when allowed) usually cost more.

• Check referral and prior authorization rules for specialist visits, imaging, and procedures.

• Travelers or snowbirds should weigh network reach and out-of-area policies.

Drug Coverage Inside MA Plans

Most MA plans include Part D:

• Confirm each medication’s formulary status, tier, and step therapy.

• Compare preferred vs standard pharmacy pricing (including mail order).

• Model your year: deductible phase (if any), typical copays or coinsurance, and protection once you hit plan limits.

Costs & Premiums: Look Beyond the Sticker

• Premium is only part of the story—add expected visit copays, tests, therapies, and procedures.

• Every MA plan sets an annual medical OOP max for covered services, capping risk.

• For drugs, check your likely annual pharmacy spend by tier and pharmacy type.

Plans may include:

• Dental (cleanings, X-rays; some include major services with caps)

• Vision (exams, lenses/frames allowance)

• Hearing (exams, aid allowances)

• Fitness/OTC (gym access or quarterly OTC credits)

Pick perks you’ll actually use—otherwise they don’t justify higher premiums.

Use CMS Star Ratings to gauge quality:

• Preventive care, chronic-condition management, member complaints, and service.

• Higher-rated plans may indicate steadier performance—but still verify your doctors and medications.

Special Needs Plans (SNPs)

If you qualify, SNPs tailor benefits and care coordination:

• D-SNP: Dual-eligible for Medicare and Medicaid

• C-SNP: Specific chronic conditions (e.g., diabetes, CHF)

• I-SNP: Institutional or nursing-home level of care

These include Medicare benefits and usually Part D, with focused care teams.

Using Online Tools (Fast Workflow)

• Enter your ZIP, medications, and pharmacies.

• Add your doctors/hospitals.

• Sort by estimated annual cost, then inspect drug tiers and provider matches.

• Shortlist 2–3 plans and read the Summary of Benefits/EOC.

• Compare your current plan to top contenders—formularies and networks change yearly.

• Confirm your providers are still in network for 2026.

• Re-run your medications—tiers and preferred pharmacies can shift.

• If already in MA, you also get Jan 1–Mar 31 to switch once or return to Original Medicare.

There’s no “best” plan—only the best plan for you. Anchor your comparison to your doctors, hospitals, and prescriptions, then weigh total cost and benefits. Use Plan Finder filtering to expose real costs and lean on a licensed agent for a quick side-by-side before you lock in for 2026.

FAQs

What is a Medicare Advantage plan?

A Part C plan from a private insurer that includes Parts A and B—and often Part D—plus extra benefits, with an annual medical OOP max.

How do I compare effectively?

Match plans to your doctors and medications, model annual total cost, and verify extras you’ll use. Online tools make this fast.

Why pick a PPO?

Provider flexibility without referrals; out-of-network allowed (usually higher cost). Great for travelers or specialist access.

What extras matter most?

Dental/vision/hearing and OTC/fitness can add real value if you’ll use them—otherwise focus on network and total cost.

When can I switch?

AEP: Oct 15–Dec 7. If already in MA, MA OEP: Jan 1–Mar 31 to switch once or go back to Original Medicare.