There is no single best Medicare Advantage plan, and anyone who names one without asking for your ZIP code is selling something. The plan that is excellent for your neighbor can be a bad deal for you if your cardiologist is out of network or your medication sits on a high tier. What you can do is learn which numbers separate good plans from risky ones, and check them before the December deadline.
Key Answers Before You Compare Anything
These are the questions people tend to discover too late, usually in January, when the new plan card arrives and the doctor’s office says it does not take it.
The one that covers your doctors and your drugs at the lowest total yearly cost in your county. Plans are sold county by county, so a national “best” list cannot tell you that. Use Medicare’s Plan Finder with your exact medications and providers, then weigh premium plus the out-of-pocket maximum rather than the premium alone.
The annual window is October 15 through December 7, with changes starting January 1. If you are already in a Medicare Advantage plan, you get a second chance from January 1 to March 31 to switch to another Advantage plan or return to Original Medicare. Most people who simply want to keep their plan do not need to re-enroll.
No. You still pay your Medicare Part B premium, and the plan can charge copays, coinsurance, and deductibles until you reach its out-of-pocket maximum. A $0 plan with a $9,000 maximum can cost far more in a bad year than a $60 plan with a $3,500 maximum.
Every plan must cap in-network Part A and B costs. For the coming year the federal ceiling is $9,850 for in-network care, and up to $14,800 combined with out-of-network care on a PPO, as reported from CMS’s final figures. Many plans set theirs lower. Drug costs are capped separately at $2,400 inside plans that include drug coverage.
KFF’s first look at insurers’ own 2025 data found Medicare Advantage insurers denied about 12% of standard prior authorization requests, ranging from roughly 5% at Elevance to 17% at UnitedHealth Group among the largest. Denials are rarely appealed, but when they are, about two in three get overturned.
They help, but they do not guarantee your doctors or drugs are covered. For the coming year, about 37% of drug-covering Advantage contracts earned four stars or more, down from 44%, and only 15 earned five stars. Treat stars as a tiebreaker after you confirm your own providers and prescriptions.
Yes, during open enrollment or the January to March window. The harder part is Medigap. In most states, a supplement insurer can ask health questions and decline or charge more if you apply outside certain protected windows, so decide before you give up a supplement you already have.
Your State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling, and 1-800-MEDICARE is open around the clock. Both are better starting points than a TV ad or a mailer, because neither earns a commission on the plan you pick.
The Numbers That Separate a Good Plan From a Risky One
When we compared this year’s published figures with what CMS announced for next year, the headline looked cheerful and the fine print looked different. Premiums are falling on average. The ceilings on what you can be asked to pay are rising.
The average premium is an enrollment-weighted figure across the whole country. It says nothing about the plan in your county, and it says even less about the year you land in the hospital. In a quiet year you pay little. In a bad year the number that governs your bill is the out-of-pocket maximum, which the federal ceiling lets plans set $600 higher than this year’s ceiling.
CMS estimates about 34 million people, roughly 47% of everyone on Medicare, will be in an Advantage plan. More than 99% of beneficiaries can reach at least one plan, and 97% can reach ten or more. About eight in ten enrollees should be able to stay in their current plan at the same or a lower premium, which is why checking is worth the effort: the other two in ten may face changes.
HMO, PPO, or Special Needs: Picking the Plan Type First
Choosing the structure before the brand narrows the field fast. The plan type decides how much freedom you have with doctors, which is where most regret comes from.
| Option | How doctors work | Medical cost ceiling | Premium pattern | Best for | Watch out for |
|---|---|---|---|---|---|
| HMO | Plan network; referrals often needed for specialists | Up to $9,850 | Often the lowest, including $0 | People who live near the plan’s doctors and want low premiums | Little or no coverage outside the network except emergencies |
| PPO | Network plus out-of-network at higher cost | Up to $9,850 in-network; up to $14,800 combined | Often higher than HMOs | Travelers and people who want some out-of-network freedom | Out-of-network bills can climb toward the combined limit |
| Special Needs Plan (SNP) | Network built for a specific group | Same federal ceiling | Varies; dual-eligible plans can be low | People with both Medicare and Medicaid, certain chronic conditions, or in facilities | You must qualify; losing eligibility can end enrollment |
| Original Medicare + Medigap + Part D | Any provider that accepts Medicare, nationwide | No ceiling in Original Medicare; most Medigap plans have none | Higher: Part B premium plus Medigap plus a drug plan | People who split time between states or want fewer surprises | Medigap may require health questions if you apply late |
*Most Medigap plans carry no out-of-pocket maximum. Only a couple of lesser-used plan letters do.
What Star Ratings Do and Do Not Tell You
CMS published the new ratings on October 8, a week before enrollment opens. They score how plans perform on care quality and member experience, using data from previous years.
Fewer contracts earned four stars, yet 71% of people sit in highly rated ones. That is because a few very large contracts dominate enrollment. It also means your own plan’s rating matters more than any national average. Nonprofit insurers were more likely to reach four stars, about 44% versus 34% for for-profit ones, though 14 of the 15 five-star contracts belong to for-profit carriers. Healthcare Dive’s analysis showed Humana’s share of members in four-star-plus plans rising sharply for the coming year, a reminder that ratings can swing quickly and that a carrier’s past reputation may be out of date.
KFF analyzed the prior authorization data insurers were first required to publish for 2025. Medicare Advantage insurers denied about 12% of standard requests on average. Among the six largest, standard-request denial rates ran from about 5% at Elevance to 17% at UnitedHealth Group. Only a small share of denials get appealed, but about two-thirds of the appealed ones were overturned. If your doctor says a test or procedure needs approval, appeal rather than assume the first answer is final.
Check the Worst-Case Cost and Your Readiness
Two quick tools. The first shows the most a plan could cost you in a bad year. The second tells you whether you have done the checks that prevent January surprises.
Which Situation Sounds Like Yours
Start with the doctor, not the plan. Medicare’s Plan Finder now lets you find and save your providers so you can see which plans include them. Then call the doctor’s billing office and ask whether they accept that specific plan, by its full name, for next year. Networks change in January, and a doctor in network this year is not guaranteed to stay. If your doctor is out of network on every affordable Advantage plan in your county, that is a real signal to price Original Medicare with a supplement.
If you take brand-name or specialty drugs, run them through the Plan Finder before looking at anything else. Drug costs inside Advantage plans now follow the same structure as standalone plans: a deductible of up to $700, then a cap of $2,400 for the year, after which covered drugs cost you nothing. The Medicare Prescription Payment Plan can spread those costs into monthly installments if a big bill hits early in the year. Compare how each plan tiers your specific drugs, because two plans with the same premium can charge very different copays for the same pill.
This is where HMOs trip people up. Many HMOs cover only emergency and urgent care outside their service area, so a planned visit to a specialist in another state may not be covered at all. PPOs and some HMOs with travel features are friendlier, but read the evidence of coverage, not the brochure. If you live in two states, Original Medicare with a supplement works nationwide with any provider that accepts Medicare, which is often what snowbirds end up choosing.
Ask about dual-eligible Special Needs Plans, which are built to coordinate both programs and can reduce what you pay. Also check Medicare Savings Programs and Extra Help, which can pay your Part B premium and reduce drug costs. CMS notes that people in a Medicare Savings Program automatically qualify for Extra Help. Your state Medicaid office or SHIP counselor can tell you which combination you are eligible for, and they can do it for free.
You have two windows to act. Open enrollment runs through December 7, and a second window from January 1 to March 31 lets people already in Advantage plans switch to another plan or return to Original Medicare. Before leaving, check whether the new plan covers your doctors and drugs, and if you are heading to Original Medicare, sort out your supplement first. In most states you cannot count on being accepted for a Medigap policy at the same price if you wait.
Do not stop at the first no. Ask your doctor’s office to request reconsideration and to document why the care is medically needed. The deadline is printed on your denial notice, and the usual window is around two months, so act promptly. Because roughly two-thirds of appealed denials were overturned in KFF’s analysis, an appeal is not a long shot. If the plan still refuses, your SHIP counselor or the Medicare Rights Center can walk you through the next level of review.
Free, Unbiased Help Before You Enroll
None of these contacts earns a commission on the plan you choose, which is why they are worth calling first.
1-800-MEDICARE is available 24 hours a day, every day, and the Plan Finder at Medicare.gov shows premiums, costs, benefits, and star ratings side by side. Your State Health Insurance Assistance Program offers one-on-one counseling at no charge. The Medicare Rights Center runs a national helpline for appeals and enrollment problems.
Plan averages and enrollment projections are from CMS’s September 28, 2026 announcement for the coming plan year: average Medicare Advantage premium $12.00 versus $14.37, about 34 million projected enrollees, 5,532 plans versus 5,553, and open enrollment from October 15 through December 7. Star ratings figures are from CMS’s October 8, 2026 release. Prior authorization findings are from KFF’s analysis of insurer-reported data for 2025. The $9,850 in-network and $14,800 combined out-of-pocket ceilings for the coming year are as reported from CMS’s final rule, and this year’s in-network ceiling is $9,250. Part D deductible up to $700 and the $2,400 drug cap are the figures reported for the coming year. Plans, premiums, networks, and benefits vary by county and change each year, so confirm everything in the Medicare Plan Finder or with the plan before enrolling. This page is independent, is not affiliated with any insurer or the government, and is educational information, not medical, legal, or financial advice.
Key sources: CMS · Medicare.gov · KFF · SHIP · Medicare Rights Center