5 Common Medicare Advantage Plan Features to Compare During AEP
Medicare Advantage plans vary significantly across carriers and plan types. During Annual Enrollment Period, focusing on these five features helps you make a meaningful comparison rather than choosing based on premium alone.
Out-of-Pocket Maximum. Medicare Advantage plans must cap your annual out-of-pocket costs for covered services. Compare these maximums across plans—the differences can be thousands of dollars. A plan with a lower premium but much higher out-of-pocket maximum may cost more in a year with significant health needs.
Provider Network. HMO plans require referrals and restrict care to network providers. PPO plans allow out-of-network care at higher cost. Verify your current doctors, specialists, and preferred hospitals are in each plan's network. Not all networks are equal in size or the quality of included providers.
Prescription Drug Formulary. If the Medicare Advantage plan includes Part D drug coverage (MAPD plans), review the formulary carefully. Look up your specific medications by name and dosage to verify coverage, tier placement, and any restrictions like prior authorization or quantity limits.
Extra Benefits. Many Medicare Advantage plans include dental, vision, hearing, fitness memberships, transportation, and over-the-counter allowances. Evaluate whether you'll actually use these benefits and factor their realistic value into your comparison rather than their stated maximum.
Star Ratings. CMS assigns Medicare Advantage plans a Star Rating of 1-5 based on quality and performance measures. Higher-rated plans have demonstrated better performance on health outcomes, member experience, and administrative measures. Star Ratings provide one objective data point for comparing plan quality.
