4 things to consider when choosing a Medicare plan

Choosing the right Medicare plan is one of the most important health decisions you’ll make – but it doesn’t have to be overwhelming. Whether you're turning 65 or looking to switch plans, understanding your options can help you feel confident and empowered.

Here are four key factors to help guide your decision:

1. Your doctors and network access

Some Medicare plans — like Medicare Advantage HMOs — require you to use doctors and hospitals within a specific network. Others, like PPOs, offer more flexibility to see providers outside the network.

Ask yourself:

• Are my primary care doctor and specialists in-network?
• Will I need referrals to see specialists?

Use our doctor finder tool to check if your providers are included in a Medicare Advantage plan’s network.

2. Rx coverage

Not all plans cover the same drugs the same way. Each plan has its own formulary (list of covered drugs), and coverage can vary in cost by tier and pharmacy.

Ask yourself:

• Are all of my current prescriptions covered?
• How much will I pay for generics vs. brand-name medications?
• Are there preferred pharmacies that offer better pricing?

Tip: Use the drug lookup tool to see how your prescriptions are covered under our plans.

3. Plan benefits that go beyond medical care

Medicare Advantage plans often include extra benefits you won’t get with Original Medicare, like:

• Dental, vision, and hearing coverage
• Fitness memberships
• Over-the-counter allowances for health items
• Transportation to medical appointments
• Telehealth services

These “extra” benefits can make a big difference in your health, budget, and lifestyle.

4. Total costs — not just monthly premiums

While a $0 premium sounds appealing, it’s important to look closely at the total value of a plan – not just the cost. That includes:

• Monthly premiums
• Copayments for doctor visits or hospital stays
• Deductibles
• Out-of-pocket maximums

Ask yourself:

• How often do I see doctors or specialists?
• Could a higher monthly premium save me more in out-of-pocket costs?
• Do I need protection from high medical bills?

Tip:See how different plans stack up based on your health needs. There are several paths to take when it comes to Medicare, and several ways to bundle benefits into a plan that works for you.

Looking for more information?

We’re here to help you make an informed, confident choice:

• Talk to a licensed Medicare advisor: Call us at  855-258-3038 (TTY: 711). Our Medicare Plan Experts are available 7 days a week from 8 AM–8 PMET.
• Visit Medicare.gov for basic information.
• Check our FAQ below.

Frequently Asked Questions

Original Medicare is Medicare Parts A and B. It is administered by the federal government.

Medicare Advantage (Part C) is provided by private insurance companies, like Blue Cross NC. It covers the same types of care as Medicare Parts A and B but may lower your share of the costs when you use doctors and hospitals that are part of the plan’s network.

In addition, most Medicare Advantage plans offer prescription drug coverage (Part D) and supplemental benefits such as gym memberships, vision coverage, dental coverage, and more.

There are two opportunities for Medicare-eligible people to switch plans: the Annual Enrollment Period (AEP) October 15 to December 7 and the Open Enrollment Period (OEP) January 1 to March 31.

For example, if you enroll or switch plans in the fall but decide you don't like the plan once your coverage begins in January, you can switch back to Original Medicare or another Medicare Advantage plan before March 31.

You can also change plans anytime you qualify for a Special Enrollment Period.

Some medications may be covered under Original Medicare's Part B benefits. For more robust coverage, you may purchase a Medicare Rx (Part D) plan to add to Original Medicare or purchase a Medicare Advantage plan that includes prescription drug (Part D) coverage.

With Original Medicare and Medicare Supplement, you can see any doctor or visit any hospital that accepts Medicare. Some plans also offer coverage for foreign travel and foreign emergency care. With Medicare Advantage PPO plans, you may use your out-of-network benefits when traveling outside the service area. Medicare Advantage HMO plans require you stay in the network for your medical care, however, in the event of an emergency, you’re covered.