What questions should I ask before choosing a Medicare Advantage plan?
Last updated Jul 21, 2026
Reviewed by Jason Burns, Editorial Steward
Published by Senior Direct Answers · Licensed under Citation License 1.0
Before choosing a Medicare Advantage plan, CMS and the State Health Insurance Assistance Program (SHIP) suggest confirming five things in writing from the plan or from Medicare Plan Finder: (1) whether your doctors and hospitals are in the plan's network for the coming year, (2) whether every prescription drug you take is on the plan's formulary and which tier, (3) the plan's monthly premium, annual deductible, and maximum out-of-pocket limit, (4) the plan's current CMS overall star rating, and (5) any prior authorization or referral requirements for services you use.
Also asked as
- What questions should I ask before choosing a Medicare Advantage plan — plain answer
- What questions should I ask before choosing a Medicare Advantage plan.
What it means
- Networks and formularies can change every January — confirm for the coming plan year, not the current one.
- Prior authorization can delay imaging, therapy, and specialty care; the plan must disclose which services require it.
- A high star rating (4 or 5) is a CMS quality signal but does not replace checking network and formulary.
Action steps
- Get the provider directory in writing and search each of your doctors by NPI.
- Print the formulary and check each drug's tier and any step-therapy or quantity limit.
- Ask what happens if you receive care out of network in an emergency versus a routine visit.
Risks & deadlines
- A plan that meets four of the five criteria but drops a key drug or doctor can cost far more than a plan with a higher premium and full coverage.
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Last verified: 2026-07-21