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What to Look for When Shopping for a Medicare Advantage Plan
Last Updated: June 2025 Print This Article
Medicare Advantage (MA) plans offer a wide range of benefits beyond Original Medicare, but not all plans are the same. Network, coverage, costs and extra benefits can vary, making it important to understand the differences before choosing a plan. Take a look at all the things to consider so you can choose your plan with confidence.
Understand the Different Plan Types
Medicare Advantage isn’t one-size-fits-all. There are several types of plans to choose from:
- HMO (Health Maintenance Organization): You’ll typically choose a primary care physician and need referrals to see specialists. These plans usually require you to use in-network providers, except in emergencies.
- PPO (Preferred Provider Organization): offers more flexibility, allowing you to see out-of-network providers (usually at a higher cost) without a referral.
- HMO-POS (Point of Service): a hybrid between HMO and PPO plans, giving some out-of-network coverage while still needing a primary doctor.
- PFFS (Private Fee-for-Service): You can see any Medicare-approved provider who agrees to the plan’s terms, but not all providers accept them. You’ll usually pay more to see out-of-network providers.
- SNP (Special Needs Plans): tailored for people with specific health conditions or circumstances like chronic illness or dual eligibility with Medicaid.
- MSA (Medical Savings Account): combines a high-deductible health plan with a bank account you can use for medical expenses.
Check If Your Doctors and Pharmacies Are In-Network
If keeping your current doctors is important to you, make sure they’re included in the plan’s network. Even if they’re not, many plans offer strong provider networks with quality care options. The same is true for your pharmacy; verify that your preferred location is in the plan’s network.
Review the Extra Benefits
Medicare Advantage plans go beyond Original Medicare. Many include extras like dental, vision, hearing, fitness memberships, over-the-counter allowances, wellness trackers and more. Think about which benefits matter most to you and your lifestyle.
Understand the Costs
Every plan comes with its own set of costs—monthly premiums, copays, coinsurance and deductibles. Some have no premiums, while others may charge higher fees in exchange for richer coverage. Be sure to review the maximum out-of-pocket limit, which caps how much you’ll spend in a year.
Consider Prescription Drug Coverage
Most MA plans include drug coverage, but not all. If you skip it, you could face a late enrollment penalty later. Even if you don’t currently take medication, it’s smart to have coverage just in case. Also, check if there’s a deductible for prescription drugs and make sure it fits your budget.
Look at Star Ratings
Medicare Advantage plans are rated 1 to 5 stars by Medicare based on quality and performance, including customer service and how well the plan helps members manage chronic conditions and stay healthy. Higher star ratings indicate better performance.
Know Your Enrollment Options
You can enroll directly through the plan, work with an independent agent or shop online at Medicare.gov.
Need help choosing a plan that meets all your needs?
Essence Healthcare works with Medicare to offer a variety of Medicare Advantage plan options. If you have questions or need help choosing based on your needs, call 1-866-536-1052 (TTY: 711) to speak with a licensed Essence Healthcare advisor.†
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