Medicare Advantage Plans: What to Compare First

Medicare Advantage plan marketing makes it sound like every plan is the best plan. In reality, Medicare Advantage plans vary significantly — especially in Kentucky, where networks differ sharply between urban and rural counties. This is the triage layer — the first five checks that narrow a long list of plans down to a short one, in priority order. Once you have two or three finalists, our full guide on how to choose between Medicare Advantage plans covers the deeper evaluation: cost-sharing detail, authorization rules, extras, and plan documents.

1. Provider Network

The single biggest factor for most people.

• Are your primary care doctor, specialists, and preferred hospitals in-network?
• Are nearby urgent care and imaging centers in-network?
• Is it HMO or PPO? HMOs generally require in-network care; PPOs allow out-of-network at higher cost.

If your doctors are not in-network, the rest of the plan details rarely matter. For a plan-type breakdown, see HMO vs PPO Medicare Advantage Plans.

2. Formulary (Drug Coverage)

• Is every prescription you take on the plan's formulary?
• Which drug tier is each prescription on?
• Does the plan require prior authorization or step therapy?
• Which pharmacies are preferred?

A plan with a lower premium can easily cost more if one of your medications is on a higher tier. See How Medicare Part D Works in Kentucky.

3. Total Annual Cost (Not Just Premium)

Compare: monthly premium, deductibles, copays, hospital cost-sharing, and out-of-pocket maximum. A $0-premium plan with a high specialist copay can be more expensive than a $30-premium plan with stronger cost-sharing.

4. Extras That Actually Matter to You

Medicare Advantage plans advertise dental, vision, hearing, OTC allowance, fitness, and transportation benefits. Ask whether the benefit amount is actually enough for what you use.

5. Plan Stability and Star Rating

CMS rates Medicare Advantage plans 1–5 stars. 4+ stars generally indicates a stable, well-reviewed plan. Stars are a useful tiebreaker when two plans look similar.

What NOT to Compare First

• Premium alone.
• TV-ad extras.
• The plan your neighbor has — your doctors and prescriptions are different.

A Quick Framework

1. Does the network fit?
2. Does the formulary fit?
3. Is the total annual cost reasonable?
4. Do the extras actually help you?
5. Is the plan stable and well-rated?

If a plan fails step 1 or step 2, keep looking — there is no point comparing copays on a plan your doctor does not accept. Order matters more than thoroughness at this stage: the goal is to eliminate poor fits quickly, then evaluate the survivors carefully using the full comparison guide.

We compare Medicare Advantage plans against your real doctor list, real prescription list, and real county — not glossy brochures.