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Questions to Ask Before Choosing a Medicare Advantage Plan

A short checklist to work through before you commit to a specific plan.

Talk to a Licensed Agent: (302) 407-0876

Start With Access and Network

Are your current doctors and pharmacies in the plan's network? Is it an HMO, which usually requires referrals and in-network care, or a PPO, which offers more flexibility for out-of-network care at a higher cost?

If you travel often or split time between locations, ask specifically how the plan handles care outside its primary service area.

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Then Check Cost and Quality

What's the plan's CMS star rating, on a 1-to-5 scale reflecting overall quality? What's the annual out-of-pocket maximum, and what would your specific prescriptions cost under the plan's formulary? Some plans offer $0 mail-order generics — worth checking if that applies to what you take.

Finally, confirm when you can make changes: the Annual Enrollment Period (October 15 – December 7) lets you switch plans each year, and if you're already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period (January 1 – March 31) gives you one more chance to switch or return to Original Medicare.

Frequently Asked Questions

It's a 1-to-5 star quality score CMS assigns to Medicare Advantage and Part D plans based on measures like customer service, member experience, and health outcomes.