5 questions to find the best Medicare Advantage plan coverage

Overwhelmed by your Medicare Advantage plan options?

You’re not alone. Most people have 34 plans to choose from.¹

But it doesn’t have to be overwhelming.

In this article, we’ll explain 5 questions to ask that may help you find a Medicare Advantage plan to get the coverage you need.

Ready to get started?

Let’s walk through the five questions you could ask to make a more informed decision.

1. What’s the cost of a Medicare Advantage plan?

It’s usually the most common question people ask about Medicare Advantage plans. You need this info to find out if the plan is within your budget:

• Monthly premiums
• Deductibles
• Copays
• Annual out-of-pocket maximums, and more…

In case you’re wondering, the out-of-pocket maximum for Medicare Advantage plans is no more than $9,350 for in-network services and $14,400 for in-network and out-of-network services combined (not including prescriptions).²

• Once you reach these amounts, the plan covers 100% of your eligible costs for the rest of the year.
• This can protect you from higher expenses if you need frequent medical care.

You could think of it like budgeting for groceries. You’ve got to know how much each item costs to stick to your budget.

The same goes for your Medicare Advantage plan. Make sure it’s affordable while covering your essential healthcare needs.

2. What extra benefits could I get with this plan?

This is one of the most popular Medicare Advantage plan questions people ask.

Why? It comes up a lot, especially if you watch TV.

• During a typical Medicare Open Enrollment period from October 1 to December 7, an estimated 644,000 commercials for Medicare Advantage plans air on TV, or about 9,500 per day for two months.³
• These commercial advertisements by Medicare Advantage carriers typically offer benefits for other health and wellness services beyond basic healthcare coverage.

TIP: Review a plan’s additional benefits along with applicable deductibles and copays to determine if they align with your healthcare needs.

3. Will my preferred doctors be included in this plan?

If you’re new to Medicare or you’re thinking about switching plans, you’ll want to find out if the doctors you see for your medical needs and have built relationships with are included in the plan’s provider network.

TIP: Make sure your doctor is in the plan’s network before you sign up.

With Medicare Advantage plans, you usually have to use doctors and hospitals within the plan’s network.

• This means you may need to choose from specific providers.
• Sometimes, you might also need approval before getting certain prescriptions or treatments.

TIP: If you find that your doctor isn’t in-network, you might have to pay more out of pocket to see them. So, it’s worth taking the time to confirm this up front.

4. Are my prescriptions covered?

Fun fact: 88% of everyone enrolled in a Medicare Advantage plan are enrolled in plans that include prescription drug coverage.⁴

But that doesn’t mean every plan with prescription drug coverage is the same. Every plan is a little bit different.

• Check to see if your current prescriptions are covered under the plan you’re considering.
• Compare costs for both brand-name and generic options.
• Find out if your favorite pharmacy is part of the plan’s network.
• Note: While most Medicare Advantage plans include prescription drug coverage, not all do.

How much will you pay for prescription drugs with a Medicare Advantage plan?

• You might have a copay when you order or pick up your prescriptions.
• However, in 2025, out-of-pocket costs for prescription drug spending is capped at $2,000 for eligible costs.⁵

5. Will I be covered when I travel?

Planning to visit family or take a much-needed vacation? This is one of the Medicare questions that’s often overlooked.

You need to know how well your plan travels with you.

• Medicare Advantage plans are required to offer emergency coverage outside your service area within the United States.⁶
• Medicare Advantage plans may not cover you outside the United States, but Medigap plans sometimes do. ⁷ Check your coverage details before you travel.

Get your Medicare questions answered

Have more questions? Just give us a call at (800) 827-9990 to speak with a licensed health insurance agent or find a licensed health insurance agent in your area.

We’ll help you compare Medicare Advantage plans, check your doctor and prescription coverage, and find the right fit for your health and budget.