How to Compare Medicare Advantage Plans Before AEP
Comparing Medicare Advantage plans well comes down to three things: what a plan costs you across a whole year given the drugs you actually take, whether the doctors and hospitals you use are in its network, and what rules the plan puts between you and your care. Everything else — the premium on the mailer, the extra benefits in the commercial — is secondary to those three.
The useful thing to know is that you can do most of this work before Open Enrollment even opens. Plan information for the coming year becomes available October 1, and Open Enrollment runs October 15 through December 7. The two weeks in between are the quiet stretch when the comparison is easiest and nobody’s rushing you.
One naming note first: agents and insurance companies say “AEP,” short for Annual Election Period. Medicare’s own materials say “Open Enrollment.” Same window, same dates. If someone tells you AEP is a different thing with a different deadline, they’re mistaken.
Before you compare anything, write three lists
The comparison only works if you feed it accurate information about yourself. Sit down and write out:
- Every prescription you take, with the exact dosage and how often. Not “my blood pressure pill” — the drug name and the milligrams. This is the single biggest driver of what a plan will actually cost you, and it’s the input people fudge.
- The doctors, specialists, and hospitals you want to keep. Include the specific clinic or practice location, since networks are contracted by provider and location, not by brand name.
- The pharmacy you use. Plans have preferred and standard pharmacies, and the same drug can carry a different copayment depending on where you fill it.
Ten minutes on these lists prevents the most common bad outcome: choosing a plan that looked fine in general and turns out not to fit you in particular.
Read the two documents your current plan sends you
If you’re already in a Medicare Advantage plan, two pieces of mail arrive in September and they’re the starting point for any comparison.
The Annual Notice of Change (ANOC) lists what’s changing for next year, laid out against what you pay now. The Evidence of Coverage (EOC) is the longer document with the full details of what the plan covers and what you pay. Medicare’s guidance is to review both and decide whether the plan will still meet your needs. If September ends and neither has shown up, call your plan and ask for them.
Read the ANOC before you look at any other plan. It tells you whether you have a problem to solve or just a box to check.
Use Medicare’s Plan Finder, and use it with your own data
The comparison tool at Medicare.gov/plan-compare is the one built to answer the question you’re actually asking. According to Medicare, it lets you compare plans side by side, get estimates of your total out-of-pocket costs, see quality and customer service ratings from current plan members, and — this is the part that matters — get customized cost information for your preferred pharmacies and the specific prescriptions you take.
Entering your drug list turns a generic price sheet into a number that applies to you. A plan with a lower premium but worse tier placement for one of your medications can cost you more over twelve months than a plan with a higher premium. You can’t see that from the outside.
What to compare, in order
| What to check | Why it matters |
|---|---|
| Estimated total yearly cost with your drugs | The only number that reflects premium, deductible, copays, and your actual prescriptions together |
| Whether your doctors are in network | Networks are rebuilt every year; being in-network this year guarantees nothing about next |
| The plan’s yearly out-of-pocket limit | This is your worst-case ceiling for covered services in a bad year |
| Drug rules on your specific medications | Prior authorization, step therapy, and quantity limits can block a drug the formulary technically covers |
| Plan type (HMO, PPO, and so on) | Determines referrals, out-of-network access, and how much freedom you have |
| Extra benefits you’ll actually use | Dental, vision, hearing, and over-the-counter allowances aren’t standardized between plans |
Plan type shapes more than people expect
Two plans with similar premiums can behave very differently depending on their structure. Medicare’s own comparison of Medicare Advantage plan types lays out the differences:
- HMO — You generally must use providers in the plan’s network, except for emergency care, urgent care, and out-of-area dialysis. You usually choose a primary care doctor, and you need a referral to see a specialist. An HMO Point-of-Service (HMOPOS) plan may let you get some services out of network at a higher cost.
- PPO — There’s a network, but you can go outside it, typically paying more. No referral needed for a specialist.
- PFFS — You can see any Medicare-approved provider who accepts the plan’s payment terms and agrees to treat you. That last part is a real condition, not a formality.
- SNP — All Special Needs Plans must include drug coverage. Referral and network rules depend on whether the SNP is built as an HMO or a PPO.
- MSA — Medical Savings Account plans have no separate monthly premium and generally no provider network, but you join a separate drug plan for Part D.
One rule cuts across all of them: with a Medicare Advantage plan you’ll typically need prior authorization from the plan before it covers certain services or supplies. Under Original Medicare you usually don’t. If you have a procedure coming up, that difference is worth understanding before you enroll, not after.
Where comparisons go wrong
Comparing premiums instead of totals. A plan’s premium is one line in a budget that also includes deductibles, copayments, coinsurance, and drug costs. Medicare Advantage plans do have a yearly limit on what you pay for covered services — Original Medicare has none without supplemental coverage — but plans set that limit at different levels, and some set separate limits for in-network and out-of-network care.
Treating a star rating as a plan rating. CMS rates contracts, not individual plans, and a single contract can cover several plan offerings. For the 2026 ratings, Medicare Advantage plans with drug coverage were scored on up to 43 quality measures, plans without drug coverage on up to 33, and standalone drug plans on 12. CMS resets the scoring thresholds every year and changes which measures count, so a rating that moved is not automatically a plan that changed. About 40% of Medicare Advantage prescription drug contracts offered in 2026 earned four stars or higher. A rating is a useful signal about customer service and care quality. It is not a substitute for checking your own drugs and doctors.
Assuming “covered” means “available.” A drug can be on the formulary and still require prior authorization, step therapy — trying a less expensive drug first — or be subject to a quantity limit. Check the rules attached to your medications, not just whether the name appears on the list. Medicare does require plans to offer a transition fill in some situations: a one-time 30-day supply of a drug you’ve been taking that the new plan doesn’t cover or requires approval for. That’s a bridge, not a solution.
Trusting a network directory without calling. Directories go stale. If keeping a particular doctor is the reason you’re switching, call that office, give them the plan’s full name, and ask whether they’ll be contracted with it next year.
Forgetting the Medigap consequence. You can’t use a Medicare Supplement (Medigap) policy to cover a Medicare Advantage plan’s costs. If you drop a Medigap policy to join a Medicare Advantage plan, whether you can get it back later depends on your state’s rules and your situation. Learn your state’s rules before you cancel anything.
One note about next year’s numbers
Some figures for a coming plan year aren’t published until the fall. For 2026, CMS set Medicare’s drug benefit deductible at no more than $615 and the annual out-of-pocket threshold at $2,100, after which you pay nothing for covered Part D drugs for the rest of the year. Your plan’s own 2027 amounts will appear in your ANOC and on Medicare.gov/plan-compare in October. Anyone quoting you a figure for a future year before CMS publishes it is guessing.
The calendar
| Date | What happens |
|---|---|
| September | ANOC and EOC arrive from your current plan |
| October 1 | Next year’s plan information becomes available; start comparing |
| October 15 | Open Enrollment begins |
| December 7 | Open Enrollment ends — your plan must have received your form |
| January 1 | New coverage takes effect |
Free help is available and it isn’t tied to any plan. Your State Health Insurance Assistance Program offers personalized counseling — find your local number at shiphelp.org — and 1-800-MEDICARE is staffed 24 hours a day, including weekends.
Sources: Medicare.gov, “Compare types of Medicare Advantage Plans” (medicare.gov/health-drug-plans/health-plans/your-health-plan-options/compare); Medicare.gov, “Compare Original Medicare & Medicare Advantage” (medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage); Medicare.gov, “Drug plan rules” (medicare.gov/health-drug-plans/part-d/what-drug-plans-cover/plan-rules); Medicare.gov, “Evidence of Coverage (EOC)” (medicare.gov/basics/forms-publications-mailings/mailings/costs-and-coverage/evidence-of-coverage); CMS Product No. 11220, “Your Yearly Medicare Review,” September 2025 (medicare.gov/publications/11220-your-yearly-medicare-review.pdf); CMS Fact Sheet, “2026 Medicare Advantage and Part D Star Ratings,” November 18, 2025 (cms.gov/files/document/2026-star-ratings-fact-sheet.pdf); CMS Fact Sheet, “Final CY 2026 Part D Redesign Program Instructions” (cms.gov/newsroom/fact-sheets/final-cy-2026-part-d-redesign-program-instructions).
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
This content is for general educational purposes and is not a complete description of benefits. Contact the plan for more information. Medicare Compare Agency, 2201 Providence Park, #150, Birmingham, Alabama 35242.