Written By

Greg Wohl

Licensed Medicare Specialist

Medicare Advantage (Part C) plans are offered by private insurers approved by Medicare. They bundle Parts A and B coverage and usually include Part D prescription drug coverage and extra benefits like dental, vision, and hearing.

In Florida, beneficiaries in most counties have access to 30 or more Medicare Advantage plans. The sheer number of options makes choosing feel overwhelming. But the decision becomes manageable when you evaluate plans against a clear set of criteria that match your specific health needs and budget.

This guide walks you through a seven-step process for comparing and choosing the right Medicare Advantage plan in 2026.

Key Takeaways

Start with your doctors and prescriptions: Before comparing premiums or extra benefits, confirm that your current doctors are in-network and your medications are on the plan's formulary. A plan with a $0 premium that does not cover your doctors or drugs will cost you far more than a plan with a modest premium that does.
HMO vs. PPO is a fundamental choice: HMO plans require you to use in-network providers and get referrals for specialists. PPO plans allow out-of-network care at higher cost-sharing and do not require referrals. If you travel frequently or see specialists regularly, a PPO may be worth the higher premium.
The out-of-pocket maximum is your financial safety net: In 2026 the maximum out-of-pocket limit for Medicare Advantage is $9,350 for in-network services. Plans can set lower limits. A plan with a $3,000 OOP max provides much stronger financial protection than one with a $9,350 limit, even if the premium is higher.
Drug formularies change every year: Even if you are happy with your current plan, your medications may be moved to a higher tier or removed from the formulary for the next plan year. Always run a formulary check during the Annual Enrollment Period (October 15 to December 7).
Extra benefits vary widely and are not always valuable: Dental, vision, hearing, OTC allowances, and transportation benefits sound attractive but vary enormously in actual value. A $500 dental allowance that only covers cleanings and X-rays is very different from one that covers crowns and root canals.
Star ratings reflect plan quality: Medicare rates every Medicare Advantage plan on a 1 to 5 star scale based on quality measures including customer service, chronic disease management, and member satisfaction. Plans with 4 or 5 stars are generally more reliable and have fewer coverage disputes.

Step 1: Confirm Your Doctors Are In-Network

The first and most important step is verifying that your current primary care physician and any specialists you see regularly are in the plan's network.

For HMO plans, using out-of-network providers (except in emergencies) is typically not covered at all. For PPO plans, out-of-network care is covered but at significantly higher cost-sharing. Either way, staying in-network is almost always the financially correct choice.

How to check: Use the plan's online provider directory or call the plan directly. Do not rely on your doctor's office to know which plans they accept, as this information is sometimes outdated. Confirm directly with the plan.

What to check for each provider:

Primary care physician
Cardiologist, oncologist, or other specialists you see regularly
Your preferred hospital system
Any outpatient surgery centers or imaging facilities you use

Step 2: Check Your Prescriptions Against the Formulary

Every Medicare Advantage plan with drug coverage (MAPD) has a formulary, which is the list of covered medications organized into tiers. Higher tiers mean higher cost-sharing.

How to run a formulary check: Use the Medicare Plan Finder at medicare.gov/plan-compare and enter your medications. The tool will show you the estimated annual drug cost for each plan based on your specific prescriptions.

What to watch for:

Is each medication on the formulary at all?
What tier is it on? Tier 1 (generic) is cheapest; Tier 4 or 5 (specialty) can cost hundreds per month.
Are there prior authorization or step therapy requirements?
Does the plan have a preferred pharmacy network that reduces your cost?

For more detail on Part D drug coverage and how to avoid the late enrollment penalty, see our guide on reinstating a Part D plan.

Step 3: Compare Out-of-Pocket Maximums and Cost-Sharing

The monthly premium is only one part of your total annual cost. For most beneficiaries, the out-of-pocket maximum and the cost-sharing structure for services you actually use matter more.

Key cost-sharing items to compare:

Cost Item	What to Look For
Out-of-pocket maximum	Lower is better. Range: $1,500 to $9,350 in 2026.
Primary care copay	$0 to $30 per visit is typical.
Specialist copay	$30 to $60 per visit is typical.
Hospital inpatient	Per-day copay or per-stay copay. Can be $250 to $400 per day.
Emergency room	$90 to $120 per visit is typical (waived if admitted).
Outpatient surgery	20% coinsurance or a flat copay. Check both.

If you have a chronic condition or expect significant healthcare use, prioritize plans with lower OOP maximums and lower specialist copays, even if the monthly premium is higher.

Step 4: Choose Between HMO and PPO

The plan type determines how much flexibility you have in choosing providers.

HMO (Health Maintenance Organization): You must use in-network providers. You need a referral from your primary care physician to see a specialist. Out-of-network care is not covered except in emergencies. HMOs typically have lower premiums and lower cost-sharing than PPOs.

PPO (Preferred Provider Organization): You can see any Medicare-accepting provider, in-network or out-of-network, without a referral. Out-of-network care is covered but at higher cost-sharing. PPOs typically have higher premiums than HMOs.

Special Needs Plans (SNPs): These are specialized MA plans for people with certain chronic conditions (C-SNP), dual Medicare-Medicaid eligibility (D-SNP), or institutional care needs (I-SNP). If you qualify, an SNP may offer better-coordinated care and lower costs for your specific condition.

For a broader comparison of Medicare Advantage versus Original Medicare with Medigap, see our guide on Original Medicare vs. Medicare Advantage in Florida.

Step 5: Evaluate Extra Benefits

Medicare Advantage plans can offer extra benefits that Original Medicare does not cover. These include dental, vision, hearing, fitness memberships, OTC allowances, transportation, and meal delivery after a hospital stay.

How to evaluate extra benefits: Do not let a long list of extras distract you from the core coverage factors. Instead, identify the one or two extra benefits you would actually use and calculate their real value.

Dental coverage: Look at whether the plan covers preventive care only (cleanings, X-rays) or also comprehensive care (fillings, crowns, root canals, dentures). A $500 annual dental maximum that only covers preventive care is much less valuable than it appears.

OTC allowance: Many plans offer a quarterly or annual allowance for over-the-counter items. Check whether the allowance is usable at major pharmacies or only through a mail-order catalog.

Fitness benefits: Most plans include SilverSneakers or a similar gym membership program. If you use a gym regularly, this benefit has real dollar value.

For more detail on how Medicare Advantage benefits have changed in 2026, see our guide on Medicare Advantage changes in 2026.

Step 6: Check the Plan's Star Rating

Medicare rates every Medicare Advantage plan annually on a 1 to 5 star scale. The rating reflects quality measures including customer service responsiveness, chronic disease management, preventive care rates, member complaints, and appeals outcomes.

Why star ratings matter: Plans with 4 or 5 stars tend to have fewer coverage disputes, better care coordination, and more responsive customer service. Plans with 3 stars or below have documented quality issues.

Where to find star ratings: The Medicare Plan Finder at medicare.gov/plan-compare shows star ratings for every plan. You can also find them on the plan's Evidence of Coverage document.

5-star enrollment: If a plan earns a 5-star rating, Medicare allows you to switch to that plan at any time during the year using a Special Enrollment Period. This is one of the few times you can change plans outside of AEP.

Step 7: Use the Medicare Plan Finder and Compare Side by Side

Once you have identified your priorities (doctors, drugs, OOP max, plan type), use the Medicare Plan Finder at medicare.gov/plan-compare to compare plans side by side.

What the Plan Finder shows:

Estimated total annual cost based on your medications and expected healthcare use
Monthly premium and out-of-pocket maximum
Drug costs by tier and pharmacy
Provider network check
Star rating
Extra benefits summary

When to get help: If you find the comparison process confusing, a licensed Medicare specialist can run the comparison for you at no cost. Agents are compensated by the insurance companies, not by you. For personalized help comparing Medicare Advantage plans in your Florida county, schedule a free consultation with our licensed specialists.

The Bottom Line on Choosing a Medicare Advantage Plan

Choosing the right Medicare Advantage plan comes down to matching the plan to your specific health situation, not chasing the lowest premium. Here is the seven-step checklist:

Step 1: Confirm your doctors and hospitals are in-network
Step 2: Run a formulary check for all your medications
Step 3: Compare out-of-pocket maximums and cost-sharing for services you use
Step 4: Decide between HMO and PPO based on your need for flexibility
Step 5: Evaluate extra benefits you will actually use
Step 6: Check the plan's star rating
Step 7: Use the Medicare Plan Finder to compare side by side

Our licensed specialists can walk through this checklist with you and compare every plan available in your county. Schedule a free consultation to get started.