Think all Medicare plans are the same?
They aren’t: Original Medicare leaves big gaps, Medicare Advantage caps out-of-pocket costs but limits networks, and Medigap fills gaps but often doesn’t cover drugs.
Comparing Medicare plans helps you avoid surprise bills and choose the mix of access, drug coverage, and cost that fits your life.
This guide walks through the six key things to compare—plan type, monthly costs, networks, Part D rules, yearly changes, and star ratings—so you can pick coverage that matches your needs and budget.
Key Factors to Compare When Evaluating Medicare Plans
Original Medicare handles hospital care (Part A) and medical services (Part B), but it’s full of holes. You’re on the hook for 20% coinsurance on most outpatient care, and there’s no yearly cap on what you can spend. Medicare Advantage bundles Parts A and B, usually throws in Part D prescription coverage, and puts a lid on your annual costs. That cap is $9,250 in-network for 2026. Medigap fills the gaps Original Medicare leaves behind by covering copays and coinsurance, but it won’t touch prescription drugs if you bought the policy after January 1, 2006. Part D is a standalone prescription plan you add to Original Medicare or Medigap. Most Medicare Advantage plans already include it.
Cost variables swing wildly depending on plan type. Medicare Advantage plans can run $0 monthly premiums, but you still owe the Part B premium ($202.90 in 2026). Part D deductibles can hit $615 in 2026, and what you pay for meds depends on which tier your drugs land in: generic, preferred brand, or nonpreferred brand. Out-of-pocket caps shift too. In 2025, Part D caps spending at $2,000. In 2026, expect that to climb to $2,100. Hit the cap, and you enter catastrophic coverage. After that, you pay nothing for the rest of the year. Medigap policies charge a monthly premium on top of Parts A and B, and that premium climbs with age in most states.
Your ZIP code and county decide which plans you can get and what they’ll cost. Star ratings run from 1 to 5, and 5-star plans aren’t everywhere. You can enroll during your Initial Enrollment Period when you first qualify for Medicare, switch during the Annual Enrollment Period (October 15 to December 7), or use a Special Enrollment Period if you move or lose other coverage. Miss your first shot at Part D, and you’ll trigger a late-enrollment penalty that sticks around as long as you carry prescription coverage—unless you had creditable coverage from somewhere else.
Six things you need to compare:
- Plan type: Original Medicare, Medicare Advantage (HMO, PPO, PFFS, SNP, MSA), Medigap, or Part D.
- Monthly cost exposure: Premiums, deductibles, copays, coinsurance, and maximum out-of-pocket limits.
- Network restrictions: Do you have to use in-network providers and pharmacies, or can you go out-of-network at a higher cost?
- Part D coverage specifics: Formulary inclusion, drug tiers, pharmacy tiers, and whether mail-order is an option.
- Annual plan changes: Formularies, pharmacy networks, and cost-sharing can all change each year. Insurers must notify you.
- Star ratings: Plans get rated on quality and customer service. Higher stars usually mean better claims experience and member satisfaction.
How Medicare Plan Types Affect Your Experience When Choosing Coverage
Original Medicare lets you see any doctor or hospital in the United States that takes Medicare. You never need a referral to see a specialist. You’ll pay the Part B deductible ($257 in 2026), then 20% coinsurance for most outpatient services with no yearly cap on what you can spend. Hospital stays under Part A also carry a deductible ($1,676 per benefit period in 2026). Because there’s no out-of-pocket maximum, a long hospital stay or serious illness can create costs you can’t predict. You handle claims yourself, and you decide whether to add standalone Part D and a Medigap policy to fill the gaps.
Medicare Advantage plans bundle everything and often toss in dental, vision, hearing, and fitness benefits that Original Medicare doesn’t cover. Most plans require you to use in-network doctors and hospitals. HMO plans usually require referrals to see specialists, while PPO plans let you go out-of-network at a higher copay. Many plans also require prior authorization before certain tests, surgeries, or expensive medications, which can delay care. The trade-off? Simplicity and a cap on your annual spending. Once you hit the maximum out-of-pocket limit, the plan pays the rest for the year. But if the plan changes its network or formulary, your preferred doctor or pharmacy might no longer be covered. You’ll need to switch providers or pay more.
Medigap policies wipe out most cost-sharing under Original Medicare. They cover the Part A and Part B deductibles, the 20% coinsurance, and sometimes excess charges when a doctor bills more than Medicare’s approved amount. You can see any provider that accepts Medicare anywhere in the country without worrying about networks or referrals. The monthly premium runs higher than most Medicare Advantage plans, and Medigap won’t include prescription drug coverage if you bought the policy after January 1, 2006. You’ll need to enroll in a separate Part D plan to cover medications. Your total monthly cost? The Part B premium, the Medigap premium, and the Part D premium combined.
Part D plans vary in which drugs they cover, how much you pay, and which pharmacies you can use. Each plan keeps a formulary that groups drugs into tiers. Generics cost less than preferred brands, and preferred brands cost less than nonpreferred or specialty drugs. If your medication isn’t on the formulary, your doctor can request an exception, but the plan may deny it or require you to try a different drug first. Some plans limit which pharmacies you can use or charge more if you don’t use a preferred pharmacy. Your out-of-pocket costs depend on the deductible, tier placement, and whether you qualify for Extra Help. After you reach the annual cap ($2,000 in 2025, expected $2,100 in 2026), you pay nothing more for covered drugs for the rest of the year.
Final Words
Weigh what each plan actually covers: Original Medicare, Medicare Advantage, Medigap, and Part D. Know who pays for what and whether drugs are included.
Watch the big cost levers: premiums, deductibles (2026 max $615), copays, and out-of-pocket caps (2025: $2,000; expected 2026: $2,100). Check provider networks, formularies, and enrollment windows to avoid gaps or late-enrollment penalties.
Now use a plan finder, compare star ratings, and review formulary details when you compare medicare plans. Take your time. You’ll find a fit that makes sense.
FAQ
Q: What is the best way to compare Medicare plans?
A: The best way to compare Medicare plans is to compare plan type, premiums, deductibles, out-of-pocket caps, provider networks and drug formularies using the Medicare Plan Finder and local insurer tools during enrollment windows.
Q: What are the top three Medicare plans?
A: The top three Medicare plan approaches are: Original Medicare with a Medigap supplement, Medicare Advantage (MA) plans that bundle Parts A/B and usually Part D, and standalone Part D drug plans.
Q: Is montelukast covered by Medicare?
A: Montelukast coverage under Medicare depends on your Part D or Medicare Advantage drug formulary; many plans cover it but check its tier, copay, prior authorization, and pharmacy network before filling.
Q: What are the 6 things Medicare doesn’t cover?
A: Medicare doesn’t cover six common items: long-term custodial care, routine dental care, routine vision and eyeglasses, hearing aids and exams, cosmetic procedures unless medically necessary, and most care outside the U.S.