7 questions to ask before choosing a Medicare Advantage plan

1. Are my doctors and hospitals in network?

Start with the care relationships you want to keep. Many Medicare Advantage plans use provider networks, and the rules differ by plan type. Ask the office—not just the plan directory—whether each doctor will participate in the exact plan for the coming year.

• Primary care doctor
• Specialists you see regularly
• Preferred hospital and outpatient center
• Pharmacy and mail-order options

2. Are all my prescriptions covered?

Check every medication by exact name, dosage, and form. Then look at the plan’s formulary tier, preferred pharmacies, prior authorization rules, and whether a less expensive equivalent is available. A low premium can be outweighed by higher drug costs.

3. What could a difficult health year cost?

Do not compare premiums alone. Review deductibles, specialist copays, hospital costs, outpatient surgery, imaging, and the plan’s annual maximum out-of-pocket amount for covered medical services. Imagine both a routine year and a year with a hospital stay.

4. Which services need prior authorization?

Some plans require approval before certain services or supplies are covered. Ask how the process works, who submits the request, and what your appeal options are. This matters especially if you expect ongoing therapy, procedures, or durable medical equipment.

5. Will the plan work when I travel?

Emergency and urgent care are treated differently from routine out-of-area care. If you spend part of the year elsewhere, visit family often, or prefer nationwide flexibility, ask detailed questions before enrolling.

6. Are the extra benefits truly useful to me?

Dental, vision, hearing, transportation, fitness, and over-the-counter allowances can be valuable—but limits, provider networks, and eligibility rules apply. Compare what is covered, how often, and what you may still pay.

7. What may change next year?

Benefits, provider networks, formularies, and costs can change each calendar year. Read the Annual Notice of Change and review your options during the appropriate enrollment period instead of assuming last year’s fit is still the best fit.