Every year, millions of Americans face the same important question: Which Medicare Advantage plan is right for me? If you’re turning 65, already enrolled in Medicare, or helping a parent navigate their options, this guide will walk you through how to compare Medicare Advantage plans in 2026 , step by step, in plain language.
Medicare Advantage plans are offered by private insurance companies as an alternative to Original Medicare. They bundle your hospital coverage (Part A) and medical coverage (Part B) into one plan, and most include prescription drug coverage too.
Here’s the key thing to know: plan options, costs, and benefits can change every year. What worked well in 2025 may not be the best fit in 2026. That’s why it’s worth reviewing your choices annually even if you’re happy with your current plan.
What Is a Medicare Advantage Plan?
Medicare Advantage, also called Part C, is a type of Medicare health plan offered by private insurance companies approved by the federal government. When you enroll in a Medicare Advantage plan, you’re still in Medicare, but your coverage is managed by a private insurer instead of the federal government.
Here’s how it differs from Original Medicare (Parts A and B):
- Original Medicare is run directly by the federal government. You can see any doctor or hospital that accepts Medicare. You typically pay a share of costs with no annual cap on what you spend out of pocket.
- Medicare Advantage is run by private companies like UnitedHealthcare, Humana, Aetna, or Blue Cross Blue Shield. These plans often include extra benefits like dental, vision, and hearing coverage that Original Medicare does not cover. However, they usually require you to use doctors and hospitals within a specific network.
Think of it this way: Original Medicare gives you broad access but fewer extras. Medicare Advantage may offer more benefits but with more rules about where you get care.
Most Medicare Advantage plans also include Part D (prescription drug coverage), so you don’t need to buy a separate drug plan.
Step-by-Step Guide to Choosing a Medicare Advantage Plan in 2026
Choosing the best Medicare Advantage plan for seniors and retirees comes down to a handful of practical decisions. Follow these steps to compare Medicare Advantage plans with confidence.
Step 1: Confirm Your Doctors and Hospitals Are In Network
Most Medicare Advantage plans use a network, a list of doctors, specialists, and hospitals that have agreed to work with that plan. If you see a provider outside the network, you may pay significantly more or the visit may not be covered at all.
Before enrolling in any plan, check whether your primary care doctor, any specialists you see regularly, and your preferred hospital are included in the plan’s network. You can usually search a plan’s provider directory on its website or call the plan directly.
Example: Say you see a cardiologist every three months. If that cardiologist isn’t in your new plan’s network, you’d either need to switch doctors or pay much higher out-of-pocket costs for each visit.
This step matters most. A plan with great benefits means little if it doesn’t include the providers you trust.
Step 2: Compare Total Costs, Not Just Premiums
It’s tempting to pick the plan with the lowest monthly premium the amount you pay each month just to have the plan. But premiums are only one piece of the puzzle.
When comparing Medicare Advantage costs in 2026, look at the full picture:
- Monthly premium — what you pay each month (some plans have $0 premiums)
- Deductibles — the amount you pay before the plan starts covering costs
- Copays and coinsurance — your share of the cost each time you see a doctor, get a test, or fill a prescription
- Out-of-pocket maximum — the most you’d pay in a year before the plan covers 100% of costs
Example: Plan A has a $0 premium but a $50 copay for specialist visits. Plan B has a $30 monthly premium but only a $20 specialist copay. If you see specialists often, Plan B could save you money overall even though it costs more each month.
Step 3: Review Drug Coverage (Formulary)
Each Medicare Advantage plan that includes drug coverage has a formulary, a list of prescription medications the plan covers. Not all plans cover the same drugs, and the amount you pay for each medication can vary widely.
Look up every medication you currently take on each plan’s formulary. Pay attention to which tier your drug falls on. Lower tiers generally mean lower costs. Also check whether the plan requires prior authorization (advance approval) or step therapy (trying a cheaper drug first) for any of your medications.
Example: If you take a brand-name medication that costs $80 per month on one plan but only $25 on another, that difference adds up to $660 over a year.
Step 4: Check Out-of-Pocket Maximums
The out-of-pocket maximum (sometimes called MOOP) is the most you’ll have to pay for covered services in a calendar year. Once you hit that limit, the plan pays 100% of your covered costs for the rest of the year.
For 2026, the Centers for Medicare & Medicaid Services (CMS) sets a ceiling on how high this limit can be. However, individual plans may set their maximums lower than the federal ceiling.
This number is especially important if you have a chronic condition or anticipate surgery, hospital stays, or other significant medical needs. A lower out-of-pocket maximum gives you more financial protection.
Example: If one plan has a $4,500 out-of-pocket maximum and another has a $7,500 maximum, the first plan limits your worst-case annual spending by $3,000 more.
Step 5: Review Extra Benefits (Dental, Vision, Hearing, Transportation, and More)
One of the biggest reasons people choose Medicare Advantage over Original Medicare is the extra benefits. Many plans include coverage that Original Medicare does not offer, such as:
- Routine dental care (cleanings, fillings, dentures)
- Vision exams and eyeglasses
- Hearing exams and hearing aids
- Fitness programs (like gym memberships)
- Transportation to medical appointments
- Over-the-counter health product allowances
- Telehealth services
Not all plans offer the same extras, and the value of these benefits varies. Read the fine print. A plan may advertise “dental coverage” but only cover one cleaning per year with a low dollar cap.
Example: If you need hearing aids — which can cost thousands of dollars — a plan that covers even a portion of that expense could save you a significant amount compared to a plan without hearing benefits.
Step 6: Understand Star Ratings
Every year, CMS rates Medicare Advantage plans on a 1-to-5 star scale, with 5 stars being the best. These ratings reflect how well a plan performs in areas like customer service, managing chronic conditions, member satisfaction, and drug pricing.
Star ratings are a useful shortcut for comparing plan quality. Plans with higher ratings have generally performed better for their members. Plans rated 5 stars also offer a special enrollment benefit — you can switch to a 5-star plan once during the year outside of the regular enrollment period.
You can view star ratings on Medicare.gov when comparing plans.
Example: Two plans may look similar on paper, but if one has a 4.5-star rating and the other has a 3-star rating, the higher-rated plan has a stronger track record of keeping members satisfied and delivering quality care.
What’s Changing for Medicare Advantage in 2026?
Medicare Advantage plans are updated every year. Insurers can adjust premiums, change which doctors are in network, modify drug formularies, and add or remove extra benefits. That means a plan you liked last year may look different this year.
For 2026, the Centers for Medicare & Medicaid Services (CMS) continues to oversee Medicare Advantage plans and may introduce regulatory updates that affect how plans are structured, rated, or reimbursed. These changes can influence the benefits and costs available to you.
Some trends to be aware of:
- Network changes — Plans may narrow or expand their provider networks from year to year. Always re-verify your doctors are still in network.
- Benefit adjustments — Extra benefits like dental or vision allowances may increase or decrease depending on the plan.
- Premium and cost shifts — Even $0-premium plans may adjust copays, deductibles, or out-of-pocket maximums.
- Regulatory oversight — CMS has been increasing scrutiny on plan marketing practices and prior authorization requirements, which may lead to improvements in how plans operate.
The most reliable way to stay informed is to review your plan’s Annual Notice of Change (ANOC), which your plan is required to send you each fall before the enrollment period begins. This document outlines exactly what’s changing for the upcoming year.
| Feature | Original Medicare (Parts A & B) | Medicare Advantage (Part C) |
|---|---|---|
| Run By | Federal government | Private insurance companies (approved by Medicare) |
| Doctor Choice | Any doctor that accepts Medicare | Usually limited to a plan network |
| Referrals Needed | No | Often yes, for specialists (depends on HMO vs. PPO) |
| Monthly Premium | Part B premium applies; Medigap adds cost | Many plans offer $0 premiums; Part B premium still applies |
| Out-of-Pocket Maximum | ✗ No annual cap | ✓ Annual cap on spending |
| Drug Coverage (Part D) | Separate plan required | Usually included |
| Dental, Vision & Hearing | ✗ Not covered | ✓ Often included (varies by plan) |
| Extra Benefits | ✗ Not available | ✓ May include fitness, transportation, OTC allowances |
| Medigap Eligible | ✓ Yes | ✗ No |
| Best For | Those who want maximum provider flexibility | Those who want bundled coverage and extra benefits |
Common Mistakes to Avoid
Even well-informed people make avoidable errors when choosing a Medicare Advantage plan. Here are the most common ones.
1. Choosing based only on a low premium.
A $0 premium sounds great, but it may come with higher copays, a smaller network, or limited drug coverage. Always compare total costs.
2. Ignoring the provider network.
Assuming your doctor is in every plan’s network is risky. Always verify before you enroll. Switching doctors mid-treatment can be disruptive and stressful.
3. Overlooking prescription drug coverage.
Failing to check whether your medications are on a plan’s formulary can lead to unexpected costs — or the need to switch medications.
4. Not reviewing your plan every year.
Plans change annually. Benefits you relied on may be reduced or removed. Spending 30 minutes reviewing your options each fall can save you hundreds or even thousands of dollars.
5. Missing enrollment deadlines.
The Annual Enrollment Period runs from October 15 to December 7 each year. If you miss it, your options for making changes become very limited. Mark your calendar.
6. Skipping the fine print on extra benefits.
A plan may advertise dental or vision coverage, but the actual benefit may be capped at a low dollar amount. Read the Summary of Benefits carefully.
7. Not using Medicare.gov‘s Plan Finder tool.
The official Plan Finder at Medicare.gov lets you enter your medications, doctors, and preferences to compare plans side by side. It’s free and unbiased.
Get the expert support that you need!
Frequently Asked Questions
Is Medicare Advantage cheaper than Original Medicare?
It depends on your health needs. Many Medicare Advantage plans have $0 or low monthly premiums, which can make them appear cheaper. However, you’ll still pay copays and coinsurance when you use services. Original Medicare paired with a Medigap (supplement) policy may have higher monthly costs but lower out-of-pocket expenses when you need care. The best choice depends on how often you see doctors, what medications you take, and how much financial predictability you want.
Can I switch Medicare Advantage plans in 2026?
Yes. During the Annual Enrollment Period (October 15 – December 7, 2025), you can switch to a different Medicare Advantage plan for 2026 coverage. There is also a Medicare Advantage Open Enrollment Period (January 1 – March 31, 2026) during which you can switch to a different Medicare Advantage plan or drop your plan and return to Original Medicare. Certain qualifying life events may also trigger a Special Enrollment Period.
What happens if my doctor leaves the network?
If your doctor leaves your plan’s network during the year, you may be eligible for a Special Enrollment Period that allows you to switch plans outside of the regular enrollment window. In some cases, your plan may offer temporary continued coverage with that provider. Contact your plan directly to understand your options.
Do all Medicare Advantage plans include dental and vision?
No. While many Medicare Advantage plans include some dental, vision, and hearing benefits, the scope of coverage varies widely. Some plans cover only basic preventive services like cleanings or eye exams, while others offer more comprehensive coverage including dentures, eyeglasses, or hearing aids. Always check the Summary of Benefits for specifics.
What is the maximum out-of-pocket limit for Medicare Advantage in 2026?
CMS sets a federal ceiling on the maximum out-of-pocket limit for Medicare Advantage plans each year. For 2026, this limit may be adjusted from the prior year. Individual plans can set their own limits below this ceiling. Check each plan’s specific out-of-pocket maximum when comparing options, as it directly affects your financial exposure.
When is open enrollment for Medicare Advantage in 2026?
The Annual Enrollment Period for 2026 coverage runs from October 15 to December 7, 2025. This is the main window to enroll in, switch, or drop a Medicare Advantage plan. Changes made during this period take effect on January 1, 2026. The Medicare Advantage Open Enrollment Period from January 1 to March 31, 2026, provides an additional opportunity to make one plan change.
How do I compare Medicare Advantage plans in my area?
Comparing plans on your own can feel overwhelming there are dozens of options, and the details matter. That’s where our team can help. At Medicare Information Project, we help you sort through the available plans in your area, compare costs and benefits side by side, and find coverage that fits your health needs and budget.
Contact us today to get personalized guidance from someone who understands Medicare inside and out. We’re here to make the process simple and stress-free.
What Does This Mean For You?
Choosing a Medicare Advantage plan in 2026 doesn’t have to be overwhelming. The key is to approach it methodically: verify your doctors are in network, compare total costs beyond just the premium, review drug coverage carefully, and pay attention to out-of-pocket limits and extra benefits.
Remember that plans change every year. Even if you’re satisfied with your current coverage, take time each fall to review your plan’s Annual Notice of Change and compare it against other options in your area. A small investment of time can lead to better coverage and real savings.
Use the free tools available to you,especially Medicare.gov’s Plan Finder and your local SHIP counselor. These resources are unbiased and designed to help you make the most informed decision possible.
You deserve a plan that fits your health needs, your budget, and your life. Take it one step at a time, and you’ll find the right fit.