Medicare Plan Comparison Checklist for Choosing Wisely

Table of Contents

• Gathering Your Health, Coverage and Budget Information Before You Compare
• Medicare Plan Comparison Basics: Original Medicare, Medicare Advantage, Medigap and Part D
• Medicare Advantage Plan Comparison: Premiums, Networks and Out-of-Pocket Limits
• Medicare Prescription Drug Plan Comparison: Formularies, Pharmacies and Tiers
• Medicare Supplement Plan Comparison: Benefit Letters and Cost Sharing
• The Printable Medicare Plan Comparison Worksheet and Total Annual Cost Estimate
  • Estimating total annual cost under three usage scenarios
  • Verify before you enroll
• Enrollment Timing, Switching Rules and Booking Your Plan Review
• Frequently Asked Questions

Gathering Your Health, Coverage and Budget Information Before You Compare

Last Updated: October 31, 2026

Choosing a Medicare plan is easier when you start with your own numbers. Many people rush into a comparison without knowing their prescriptions, doctors or monthly budget. A medicare plan comparison checklist works best when you fill it in first, then compare.

Before you open any plan finder, gather these items in one place:

• Your Medicare card and enrollment dates. Note when your Part A and Part B coverage started.
• A full medication list. Include the drug name, strength, dose and how often you take it.
• Your preferred pharmacies. Some plans use preferred pharmacy networks with lower copays.
• Your doctors and hospitals. Write down every provider you want to keep, including specialists.
• Expected care needs. Think about planned procedures, therapy or ongoing treatment for the year.
• Your monthly budget. Decide how much you can pay in premiums and how much you could pay out of pocket.

Keeping this information on paper makes the next steps faster and more accurate.

Medicare Plan Comparison Basics: Original Medicare, Medicare Advantage, Medigap and Part D

Original Medicare has two main parts: Part A covers hospital care and Part B covers outpatient services (Parts of Medicare). Medicare Advantage (Part C) is a private plan that replaces Original Medicare and often includes drug coverage. Medigap, also called Medicare Supplement, works alongside Original Medicare to help pay some out-of-pocket costs. Part D adds prescription drug coverage to Original Medicare.

A common mistake is comparing these options as if they do the same job. They do not. Medicare Advantage plans use provider networks and set cost limits. Original Medicare with Medigap and Part D generally lets you see any provider that accepts Medicare, but premiums can be higher.

Medicare Advantage Plan Comparison: Premiums, Networks and Out-of-Pocket Limits

When you compare Medicare Advantage plans, look past the monthly premium. Check the deductible, copays, coinsurance and the maximum out-of-pocket limit. The out-of-pocket limit caps what you pay for covered in-network care in a year, which makes it a useful number for budgeting. A plan with a $0 premium and a high out-of-pocket limit can cost more in a heavy care year than a plan with a modest premium and a lower limit.

Verifying coverage continuity for your providers and ongoing treatment before you enroll is an important step that comparisons often leave out. Use this workflow for each plan you are considering:

1. Confirm each provider by name and location. Do not rely on a plan's general statement that it has a "large network." Look up every doctor, specialist, hospital, lab and imaging center you use in the plan's provider directory, and confirm the exact practice location, not just the group name.
2. Ask about referrals. Some Medicare Advantage plans require a referral from your primary care doctor before you see a specialist. If you see specialists regularly, a referral requirement can add steps and delay care. Ask the plan directly whether referrals are required for each specialist type you use.
3. Check prior authorization rules. Prior authorization means the plan must approve certain services, drugs or procedures before you receive them. Ask which of your expected services require it, and how long approvals typically take. A plan that requires prior authorization for a service you expect to need can delay treatment.
4. Verify ongoing treatment coverage. If you are mid-treatment, such as physical therapy, dialysis, chemotherapy or a planned surgery, confirm the plan covers the continuation of that treatment and the providers delivering it.
5. Re-check at renewal. Networks, referral rules and prior authorization lists can change from year to year. Verify again during the fall Annual Enrollment Period before you keep or change a plan.

Finally, compare the plan's star rating and its customer service record. Medicare publishes star ratings for Medicare Advantage and Part D plans on Medicare.gov, and you can check them there before you decide. A plan with a slightly higher premium but a stronger rating and a cleaner network for your providers may be the better long-term choice.

Medicare Prescription Drug Plan Comparison: Formularies, Pharmacies and Tiers

Part D and many Medicare Advantage plans use a formulary, which is the list of covered drugs. Drugs are placed in tiers, and higher tiers usually cost more. Check that each of your medications appears on the formulary and note its tier.

Also compare pharmacy options. Some plans charge less when you use preferred pharmacies, while others charge more at out-of-network stores. Run your full medication list through each plan's cost estimate so you see your likely annual drug spending, not just the monthly premium.

Medicare Supplement Plan Comparison: Benefit Letters and Cost Sharing

Medigap plans are labeled with letters, and you should confirm the exact benefits of each plan with the insurer. Compare the plan letters side by side and check which costs each one covers, such as the Part A deductible or Part B coinsurance. Premiums differ by insurer, age and location, so request quotes before deciding.

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Watch out: a lower premium can still leave you with higher costs if the plan covers less. Review the benefit letter from the insurer to confirm exactly what is included.

The Printable Medicare Plan Comparison Worksheet and Total Annual Cost Estimate

Use this worksheet to compare two or three plans side by side. Fill in each column using the plan documents, then total the estimated annual cost. Print it or copy it into a spreadsheet so you can reuse it each year.

Estimating total annual cost under three usage scenarios

A single number hides the trade-off between a low premium and a high out-of-pocket limit. Estimate your total annual cost under three scenarios so you can see how each plan behaves if your health changes.

• Low-use year. You see your primary care doctor a few times, fill your routine prescriptions and have no major procedures. Total = annual premium + deductible (if you use care) + expected copays + drug costs.
• Average year. You see a specialist several times, have routine labs and imaging, and fill your prescriptions. Add the expected specialist copays and lab costs to the low-use total.
• Heavy-care year. You have a hospitalization, surgery or ongoing treatment. In this scenario, your in-network spending is capped by the plan's maximum out-of-pocket limit, so total = annual premium + the out-of-pocket limit (plus any costs the limit does not cover, such as out-of-network care or services the plan excludes).

Here is a simple example using round numbers: a plan with a $0 premium and a $4,500 out-of-pocket limit may cost more in a heavy-care year than a plan with a $40 monthly premium and a $2,000 limit. Run your own numbers through all three scenarios before you decide.

Verify before you enroll

Before you commit, confirm the details in the plan's official documents, not just in marketing materials or a sales call. Request the plan's Summary of Benefits and the formulary, and check the exact drug names, dosages and tiers. Confirm the provider directory entry for each doctor and hospital, and ask about referral and prior authorization rules in writing. Verifying first helps you avoid unexpected costs for the year.

Enrollment Timing, Switching Rules and Booking Your Plan Review

Most people compare and change Medicare Advantage or Part D plans during the Annual Enrollment Period, which runs each fall. Changes to plans generally take effect January 1 (Open Enrollment). Other enrollment windows may apply to special circumstances. Check Medicare.gov for the rules that apply to you before you switch.

Switching has consequences. If you leave a Medicare Advantage plan for Original Medicare, you may need to re-check coverage for medications and providers. Confirm that your current prescriptions and doctors will stay covered before you cancel anything. Ask about prior authorization requirements too, since they can delay care after a switch.

If you want help working through your worksheet, you can request a free quote and plan review with Your Medicare Advantage Guy. An independent advisor can compare options from multiple carriers and walk you through the numbers, with no obligation to enroll.

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