When you are choosing between Original Medicare and Medicare Advantage or between Medicare Advantage Plans, here are some questions to keep in mind.

Providers, hospitals, and other facilities

  • Will I be able to use my doctors? Are they in the plan’s network?
  • Do doctors and providers I want to see in the future take new patients who have this plan?
  • If my providers aren’t in-network, will the plan still cover my visits?
  • Which specialists, hospitals, home health agencies, and skilled nursing facilities are in the plan’s network?

Access to health care

  • What is the service area for the plan?
  • Do I have any coverage for care received outside the service area?
  • Who can I choose as my Primary Care Provider (PCP)?
  • Does my doctor need to get approval from the plan to admit me to a hospital?
  • Do I need a referral from my PCP to see a specialist?


  • What costs should I expect for my coverage (premiums, deductibles, copayments)?
  • What is the annual maximum out-of-pocket (MOOP) cost?
    • Note: PPOs have different out-of-pocket limits for in-network and out-of-network care. If you’re considering a PPO, find out what the different out-of-pocket limits are for in-network and out-of-network care.
  • How much will I have to pay out of pocket before coverage starts (what is the deductible)?
  • How much is my copayment for services I regularly receive, such as PCP or specialist care?
  • How much will I pay if I visit an out-of-network provider or facility?
  • Are there higher copays for certain types of care, such as hospital stays or home health care?


  • Does the plan cover any services that Original Medicare does not?
    • Dental services
    • Vision care
    • Hearing aids
  • Are there any rules or restrictions I should be aware of when accessing these benefits?

Prescription drugs

  • Does the plan cover outpatient prescription drugs?
  • Are my prescriptions on the plan’s formulary?
  • Does the plan impose any coverage restrictions?
  • What costs should I expect to pay for my drug coverage (premiums, deductibles, copayments)?
  • How much will I have to pay for brand-name drugs? How much for generic drugs?
  • What will I pay for my drugs during the coverage gap?
  • Will I be able to use my pharmacy? Can I get my drugs through mail order?
  • Will the plan cover my prescriptions when I travel?

Coordination of benefits