How to compare the total cost and value of Medicare Advantage plans

When comparing Medicare Advantage plans, look beyond the monthly premium. Review the plan's deductible, copays, maximum out-of-pocket limit, prescription drug coverage, provider network and any extra benefits such as dental, vision, hearing or fitness programs. 

Comparing these costs and benefits together can give you a more complete picture of a plan's overall value and help you choose coverage that fits your health needs and budget.

Start by considering the healthcare services you expect to use, such as doctor visits, specialist appointments, prescription medications, lab work or ongoing treatment. Then compare each plan's premium, copays, deductibles and maximum out-of-pocket limit. Looking at these costs together can help you estimate what you may spend over the course of the year and choose a plan that fits your budget.

Not necessarily. A plan with a low or $0 monthly premium may have higher copays, drug costs or out-of-pocket expenses when you receive care. In some cases, a plan with a higher premium can provide lower overall costs if you see doctors frequently, take prescription medications or expect ongoing treatment. 

Looking at your expected healthcare usage can help you determine which plan offers the best value for your situation.

Learn more about what a “$0 premium” really means.

It depends on your healthcare needs and how you use your coverage. Some people may save money with a lower premium, while others may benefit more from lower out-of-pocket costs, broader prescription coverage or valuable extra benefits. 

Comparing total costs and benefits can help you determine which plan offers the best overall value.

Prescription drug costs can vary significantly from one plan to another. Even if two plans have similar premiums, the medications they cover and the amount you'll pay for each prescription may differ. 

Before enrolling, review the plan's drug list and confirm that your medications are covered so you can better estimate your total healthcare costs throughout the year.

The maximum out-of-pocket limit is the most you'll pay for covered medical services during the plan year. Once you reach that limit, the plan pays 100% of covered costs for the rest of the year. This protection can be especially important if you experience an unexpected illness, injury or hospitalization. 

When comparing plans, consider whether the potential savings from a lower premium are worth a higher out-of-pocket maximum.

Yes. Medicare Advantage plans use provider networks, which means covered services are often available only from participating doctors, hospitals and other healthcare providers. Before enrolling, confirm that your preferred providers are in-network and accepting the plan. Doing so can help you avoid unexpected costs and minimize disruptions to the care and relationships you've already established.

Many Medicare Advantage plans include benefits that go beyond Original Medicare. Depending on the plan, these may include dental, vision and hearing coverage, fitness programs, transportation assistance and over-the-counter allowances. 

While extra benefits shouldn't be the only factor in your decision, they can add value and help reduce out-of-pocket expenses for services you use regularly. Consider which benefits are most important to your lifestyle and healthcare needs.

See what MAPD extras come with a Priority Health Medicare Advantage plan.