Key takeaway

According to the Centers for Medicare & Medicaid Services (CMS), more than 5,700 Medicare Advantage plans carry a 2026 star rating, but the best plan for you is the one whose provider network includes your doctors, whose benefits match your health needs, and whose total cost fits your budget, not just the highest CMS rating. This guide walks through that decision step by step; see our methodology for how the data is sourced.

How to Choose a Medicare Advantage Plan in 2026

Medicare Advantage (Part C) offers an alternative to Original Medicare, bundling hospital, medical, and usually drug coverage into one plan. With hundreds of plans available in some counties, choosing the right one requires a systematic approach. This guide walks you through the key factors to evaluate.

Step 1: Verify Your Doctors Are In-Network

Before everything else, check whether your current doctors, specialists, and preferred hospitals participate in the plan's network. Most Medicare Advantage plans use HMO or PPO networks, meaning you pay more (or nothing is covered) if you go out-of-network.

  • HMO plans typically require you to stay in-network and get referrals to see specialists. They usually have lower premiums.
  • PPO plans allow out-of-network care at higher cost and don't always require referrals. They offer more flexibility.
  • PFFS plans (Private Fee-for-Service) let you see any provider that accepts the plan's payment terms, but not all providers do.

Use the insurer's online provider directory, or call the plan directly with your doctor's name and NPI number. Don't assume a doctor who accepted the plan last year is still in-network this year.

Step 2: Check the CMS Star Rating

CMS rates every Medicare Advantage plan annually on a 1–5 star scale based on quality measures including preventive care, chronic disease management, customer service, and member satisfaction. Higher-rated plans tend to deliver better care experiences.

  • 5 stars: Excellent quality. Also allows special enrollment (you can join anytime)
  • 4–4.5 stars: Above average quality
  • 3–3.5 stars: Average
  • Below 3 stars: CMS flags these plans as low-performing

Browse star ratings by county on PlainMedicare: search your state → find your county → compare plans.

Step 3: Calculate Your Real Costs

The monthly premium is only one piece of the cost picture. Calculate your estimated annual costs by considering:

  • Monthly premium: Many plans offer $0 premiums, but may have higher out-of-pocket costs
  • Annual deductible: What you pay before the plan starts sharing costs
  • Copays and coinsurance: Your share for doctor visits, specialist visits, hospitalizations
  • Out-of-pocket maximum: The most you'll pay in a year (required by law; caps at $9,250 in-network for 2026)
  • Drug costs: If the plan includes Part D, check that your prescriptions are on the formulary and review your drug tier copays

Step 4: Evaluate Supplemental Benefits

Original Medicare doesn't cover dental, vision, or hearing. Most Medicare Advantage plans add some level of these benefits:

  • Dental: Preventive cleanings and X-rays are most common. Some plans include comprehensive dental (crowns, dentures) up to $1,000–$5,000/year
  • Vision: Eye exams and a fixed allowance for glasses or contacts
  • Hearing: Hearing exams and a benefit toward hearing aids
  • Fitness: Many plans include gym memberships (e.g., SilverSneakers)
  • OTC allowance: Some plans provide a quarterly allowance for over-the-counter items

Compare supplemental benefits for plans in your county using the Rankings page or individual plan detail pages.

Step 5: Review the Drug Formulary

If the plan includes Part D drug coverage, verify that your medications are on the plan's formulary (list of covered drugs) and check which tier they fall into, lower tiers have lower copays. Formularies change every year.

Use the Medicare Plan Finder at Medicare.gov or call the plan to get a specific cost estimate for your medications.

Step 6: Consider Special Needs Plans (SNPs)

If you have a specific chronic condition (like diabetes, heart failure, or ESRD) or are dual-eligible for Medicare and Medicaid, a Special Needs Plan (SNP) may be designed to serve your specific needs with tailored benefits and care coordination.

Making Your Decision

Use this checklist before enrolling:

  • ✓ My doctors and hospitals are in-network
  • ✓ My prescriptions are covered at an acceptable cost
  • ✓ The star rating is 3.5 or higher
  • ✓ The out-of-pocket maximum fits my budget
  • ✓ Supplemental benefits match my health needs
  • ✓ I've compared at least 3 plans in my county

Where to Get Help

  • Medicare.gov Plan Finder: Official comparison tool with your specific drug costs
  • 1-800-MEDICARE: Free help from Medicare counselors, 24/7
  • SHIP (State Health Insurance Assistance Program): Free, unbiased, local counseling, find your state's program at shiphelp.org

Sources

  • Centers for Medicare & Medicaid Services. Medicare Plan Finder. medicare.gov/plan-compare
  • CMS. 2026 Medicare Advantage and Part D Star Ratings. cms.gov
  • Medicare.gov. Understanding Medicare Advantage Plans.

Frequently Asked Questions

When can I enroll in Medicare Advantage?

The Annual Enrollment Period runs October 15 – December 7. You can also enroll during your Initial Coverage Election Period (3 months before to 3 months after your Medicare Part B start date) or during a Special Enrollment Period triggered by certain qualifying events.

Can I switch Medicare Advantage plans each year?

Yes. During the Annual Enrollment Period (Oct 15–Dec 7) you can switch to any Medicare Advantage plan available in your county, switch back to Original Medicare, or change your Part D drug plan. Changes take effect January 1.

What does a 5-star Medicare Advantage plan mean?

CMS awards 5-star plans the highest quality rating. These plans typically have high member satisfaction, strong preventive care scores, and excellent chronic disease management. They also qualify for larger CMS bonus payments, which plans can use to offer enhanced benefits.

Is a lower premium always better?

Not necessarily. A $0 premium plan may have higher copays, a narrower provider network, or fewer supplemental benefits than a plan with a modest premium. Always calculate your likely total out-of-pocket costs including copays, coinsurance, and deductibles.

How do I check if my doctor accepts a plan?

Each Medicare Advantage plan maintains its own provider network. Use the plan's online provider directory or call the plan directly to confirm your specific doctors and hospitals are in-network. Always verify before enrolling.