Questions to Ask When Comparing Plans

Comparing Medicare plans side by side can feel overwhelming when every brochure claims to offer "more benefits" and "lower costs." The best way to cut through it is to walk into every comparison with the same set of questions. Here's what to ask.

Questions About Cost

• What is the monthly premium, and is it different from what I pay today?

• What is the annual deductible, and does it apply to all services or just some?

• What is the plan's maximum out-of-pocket limit? This caps what you could pay in a worst-case year [1].

• What would I pay for the specific services I use most, not just the services listed in the brochure?

Questions About Coverage & Networks

• Are my current doctors, specialists, and hospitals in this plan's network?

• Does the plan require referrals to see specialists?

• Does the plan require prior authorization for services I currently receive?

• If I travel or split time between states, does this plan cover me where I go?

Questions About Prescription Drugs

• Is each of my current medications on this plan's formulary?

• What tier is each medication on, and what does that mean for my copay?

• Is my preferred pharmacy in the plan's network, and is it a preferred pharmacy (which often costs less)?

• Are there quantity limits or step therapy requirements attached to any of my prescriptions?

Questions About Plan Quality

• What is this plan's current Star Rating, and how does it compare to other plans available in my area? [1]

• Has the plan's rating changed from last year?

• What do the member experience categories of the rating tell me about how the plan is run day to day?

Questions To Ask Yourself

Beyond the plan's fine print, take a moment to check in with your own year ahead:

• Has anything about my health changed this year that affects what I'll need from a plan?

• Am I comparing plans based on total annual cost, or just the monthly premium?

• Am I clear on the difference between what a Medicare Advantage plan offers versus a Medicare Supplement plan paired with a stand-alone Part D plan?

Working through this list on your own for every plan option in your area takes real time. SGIA Medicare Consulting specializes in Medicare Supplement, Medicare Advantage, MAPD, and Part D plans, and we can walk through these questions with you plan by plan. 

We're scheduling AEP appointments now and you can start talking with us as early as October 1, with appointments available October 15 through December 7. Visit sgiamedicare.com/schedule-appointment or call 888-284-3314.

Sources

1. Centers for Medicare & Medicaid Services. 2026 Medicare Advantage and Part D Star Ratings Fact Sheet. November 18, 2025. Found on the internet at https://www.cms.gov/files/document/2026-star-ratings-fact-sheet.pdf

2. Medicare.gov. Understanding Medicare Advantage Plans. Found on the internet at https://www.medicare.gov/publications/12026-understanding-medicare-advantage-plans.pdf

3. Medicare.gov. Find Healthcare Providers: Compare Care Near You. Found on the internet at https://www.medicare.gov/care-compare/