8 Things to Consider When Choosing a Medicare Advantage Plan This Year
As the Medicare Annual Enrollment Period (AEP) approaches, beneficiaries are faced with an important decision: stick with their current Medicare Advantage plan or explore new options. Plans change from year to year, and so do your healthcare needs, so it’s important to do more than just glance at premiums. But this year, in particular, we are going to see some significant disruption in the Medicare Advantage market, from plan terminations to a major shift toward HMO plans, among other things. When looking at your current coverage, there are some important things to consider and you should evaluate your plan options carefully to ensure your plan will meet your needs for next year.
8 Essential Things to Look for When Comparing Medicare Advantage Plans for 2026
1.Monthly Premiums and Out-of-Pocket Costs
While many Medicare Advantage (MA) plans proudly advertise $0 monthly premiums, that doesn’t mean the plan is “free.” In fact, those low premiums can sometimes be offset by higher costs in other areas of the plan. Here’s what to examine carefully:
🔹 Monthly Premiums: MA premiums can range from $0 up to $100 or more, depending on the plan and region. A $0 premium plan may be appealing at first glance, but it’s important to look beyond that. Some higher-premium plans may offer lower copays, richer benefits, or more expansive provider networks, so always weigh what you’re getting in return.
🔹 Annual Deductible: Not all MA plans have a deductible, but if they do, you’ll need to meet this amount before the plan starts paying for certain services. There can be a medical deductible, a drug deductible (for Part D), or both. High deductibles can mean higher upfront costs, especially early in the year.
🔹 Copays and Coinsurance: These are the cost-sharing amounts you pay when you use medical services. Copays are flat fees (e.g., $35 to see a specialist). Coinsurance is a percentage of the cost of the service (e.g., 20% of a procedure). These can vary widely between plans, so it’s important to evaluate the copay and consurance that you will be responsible to pay when you utilize services.
2. Inpatient Hospital Benefit:
This is a key area for all Medicare beneficiaries. In the past, many MA plans charged a flat copay per hospital stay (e.g. $300 once per admission). However, many plans are shifting to a per day model, charging a daily copay for each day of inpatient care, up to a certain number of days.
🚨 Why This Matters:
A $300 flat fee per stay is predictable and manageable.
A $300 per day fee for 5 days could cost you $1,500 for the same hospitalization.
This change can significantly increase your financial exposure during a hospital admission, especially for longer stays. Make sure to review the inpatient hospital benefit section of any plan you’re considering, and compare how it's structured.
3. Out-of-Pocket Maximum (MOOP)
Every MA plan must include a maximum out-of-pocket (MOOP) limit for covered services. Once you hit that limit, the plan covers 100% of your Medicare-covered medical costs for the rest of the year. MOOPs can range widely, from $3,000 to over $8,000 per year. Lower MOOPs mean less risk, especially if you experience a major health event. Be sure to compare this number, especially if you anticipate needing frequent care or specialist visits.
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4. Provider Network
Make sure your preferred doctors, specialists, and hospitals are in-network with the plans you are considering. Medicare Advantage plans are usually an HMO or a PPO which means they have networks, and going out-of-network can result in higher costs or no coverage at all. Call your providers directly or use the plan’s directory to double-check their participation.
5. Prescription Drug Coverage (Part D)
Many Medicare Advantage plans include Part D drug coverage, but not all plan formularies are the same and not all plans structure their Rx coverage in the same way. Consider:
Are your medications on the plan’s formulary?
What tier are your medications on and what is your copay/coinsurance for that tier?
Is there an Rx deductible? (Often, you’ll see deductibles on higher tiered medications e.g. tier 3 and above)
Are there restrictions like prior authorizations or quantity limits on my medications?
Can I go to my preferred pharmacy if I am choose this plan option?
A small change in a drug tier or copay could significantly impact your costs.
Note: There is a $2100 cap on Rx medications in 2026, a $100 increase from 2025. This means the maximum you will pay for Rx medications at the pharmacy in 2026 is $2100 (this does NOT include plan premiums).
6. Additional Benefits
One of the biggest draws of MA plans is the extra “perks” that Original Medicare doesn’t offer. This can include dental, vision, and hearing coverage, gym memberships (like SilverSneakers), over-the-counter (OTC) allowances, transportation, “spend” cards, meal delivery and more. In 2026, we may see a decrease in some of these benefits, so be sure to check these “extras” when considered your plan options. Compare these benefits across plans to see what fits your lifestyle and needs.
7. Plan Changes from Last Year
Even if you’re happy with your current plan, it may have changed. Every year, insurers adjust premiums, drug formularies, networks, and benefit structures. Review your Annual Notice of Change (ANOC) letter to compare last year’s coverage with this year’s. It’s the easiest way to avoid unexpected surprises in January.
8. Customer Service and Support
When something goes wrong, responsive customer support can make all the difference. Look for:
24/7 nurse hotlines
Online member portals
Local offices or agents
Good reviews from other members
Plans with strong support teams save you time, stress, and confusion throughout the year.
Summary
Choosing a Medicare Advantage plan isn’t just about picking the one with the lowest premium; it’s about finding coverage that truly fits your healthcare needs and budget. From monthly costs and provider networks to prescription coverage and inpatient hospital benefits, there are many important factors to consider, especially as plan structures continue to change year to year.
If you're in Blair County, PA or the surrounding region, and you’re unsure where to start, Care Compass is here to help! Our licensed, local Medicare brokers provide free, personalized assistance to help you compare Medicare Advantage plans, understand your options, and avoid costly mistakes. Contact Care Compass today for free Medicare help in Blair County, PA. We’ll walk you through your choices - step by step - so you can enroll with confidence!
Care Compass is an independent insurance agency that helps seniors navigate the complexities of Medicare and other Senior Products. Our services are offered at NO COST! Care Compass is proudly owned and operated in Blair County, Pennsylvania. We provide Medicare insurance assistance to the residents of Altoona, Hollidaysburg, Duncansville and the surrounding region. If you need assistance with Medicare, contact Care Compass today!
