How to Choose the Right Medicare Plan: A Step-by-Step Guide

Choosing a Medicare plan is one of the most important healthcare decisions you'll make, and most people don't get the help they need to make it well. With Original Medicare, Medicare Advantage, Medigap, and Part D all competing for your attention, the number of options can feel paralyzing.

Here's the problem: most "help choosing a Medicare plan" comes from commissioned insurance agents who steer you toward plans that pay them the highest commissions. That's not unbiased advice. This guide walks you through the decision-making process with no agenda, so you can choose the Medicare plan that actually fits your needs.

Understanding Your Medicare Options

Before you can get help selecting a Medicare plan, you need to understand what's available. Medicare isn't one program; it's several pieces that fit together in different ways.

The Four Parts of Medicare

• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facilities, hospice, and some home health care. Most people pay $0 premium.
• Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical equipment. Standard premium is $185/month in 2025.
• Part C (Medicare Advantage): Private insurance plans that combine Parts A and B, often with Part D and extra benefits. An alternative to Original Medicare.
• Part D (Prescription Drugs): Standalone drug plans that work with Original Medicare, or included in most Medicare Advantage plans.

For a deeper explanation, see our guide on Medicare Parts A, B, C, D Explained.

The Two Main Paths

When choosing Medicare coverage, you're essentially deciding between two paths:

1. Original Medicare + Medigap + Part D: Government-run Parts A and B, supplemented by a private Medigap policy to cover out-of-pocket costs, plus a separate Part D plan for prescriptions.
2. Medicare Advantage (Part C): A private insurance plan that replaces Original Medicare and usually includes drug coverage and extra benefits.

Each path has trade-offs. Understanding them is the key to help choosing a Medicare plan that's right for you.

5 Questions to Ask Yourself Before Choosing

Before comparing plans, answer these five questions honestly. Your answers will point you toward the right Medicare path.

1. Do You Have Preferred Doctors or Hospitals?

If you have specialists you've seen for years or a hospital you trust, this matters more than anything. Original Medicare lets you see any doctor who accepts Medicare (over 90% of physicians nationwide). Medicare Advantage plans have networks that may or may not include your doctors.

2. How Often Do You Travel or Live in Multiple States?

If you're a snowbird, full-time RVer, or travel frequently, network restrictions matter. Original Medicare + Medigap works nationwide. Most Medicare Advantage plans only cover care in your home service area, with limited or no coverage when traveling.

3. What's Your Budget for Premiums vs. Out-of-Pocket Costs?

This is the classic trade-off in Medicare:

• Higher premiums, lower risk: Medigap plans cost more monthly but cover most out-of-pocket costs. Plan G, for example, leaves you paying only the Part B deductible ($257/year in 2025).
• Lower premiums, higher risk: Many Medicare Advantage plans have $0 premiums but can have out-of-pocket costs up to $8,850/year (2025).

4. Do You Have Chronic Conditions Requiring Regular Care?

If you see specialists regularly, need frequent tests, or take expensive medications, predictable costs matter. People with cancer, diabetes, heart disease, or other chronic conditions often find that Medigap's higher premiums save money over time compared to Medicare Advantage's cost-sharing for each service.

5. How Important Is Predictability vs. Extra Benefits?

Medicare Advantage plans often include extras like dental, vision, hearing aids, and gym memberships. Original Medicare doesn't cover these. But Medicare Advantage costs are less predictable since you pay copays and coinsurance for each service.

Path 1: Original Medicare + Medigap + Part D

This is the traditional Medicare path. You get Parts A and B from the government, add a private Medigap policy to cover gaps, and enroll in a standalone Part D plan for prescriptions.

Pros

• See any doctor: Any provider who accepts Medicare, anywhere in the country
• No referrals needed: Go directly to specialists without approval
• Nationwide coverage: Full coverage anywhere in the U.S.
• Predictable costs: Medigap covers most out-of-pocket expenses
• No prior authorization: Medicare approves treatments, not insurance companies

Cons

• Higher monthly premiums: Part B + Medigap + Part D can total $300-$500+/month
• No extra benefits: Original Medicare doesn't cover dental, vision, or hearing
• Multiple plans to manage: Separate bills for Part B, Medigap, and Part D

Best For

• People who travel frequently or live part-time in multiple states
• Those with chronic conditions requiring regular specialist care
• Anyone who wants the freedom to see any doctor without restrictions
• People who prefer predictable costs over lower premiums

Learn more about your options in our Medicare Supplement Plans Guide.

Path 2: Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurance companies. They must cover everything Original Medicare covers, but they do it through managed care with networks, cost-sharing, and prior authorization.

Pros

• Lower premiums: Many plans have $0 monthly premiums (you still pay Part B premium)
• Out-of-pocket maximum: Costs are capped at $8,850/year (2025)
• Extra benefits: Most plans include dental, vision, hearing, and fitness programs
• Integrated coverage: One plan covers medical, hospital, and usually prescriptions
• Care coordination: Some plans offer care management for chronic conditions

Cons

• Network restrictions: Must use in-network doctors (HMO) or pay more out-of-network (PPO)
• Prior authorization: Many services require plan approval before they're covered
• Limited travel coverage: Most plans only cover emergency care outside your service area
• Plans change yearly: Networks, benefits, and costs can change each year
• Harder to leave: Switching to Medigap later may require medical underwriting

Best For

• Healthy people with minimal healthcare needs
• Those who don't travel often and stay in one area
• Budget-conscious people who prefer lower premiums and accept cost-sharing
• People who value extra benefits like dental and vision

For a detailed analysis, see our guide on Medicare Advantage Pros and Cons.

Side-by-Side Comparison

Here's how the two paths compare on the factors that matter most when help selecting a Medicare plan:

For a deeper dive, see our comprehensive Medigap vs. Medicare Advantage Guide.

Common Mistakes When Choosing a Medicare Plan

Even with help choosing a Medicare plan, people make these costly mistakes:

Choosing Based on Premium Alone

A $0 premium Medicare Advantage plan isn't "free." You pay through cost-sharing each time you use healthcare. A healthy year might cost you less, but a year with surgery or a new diagnosis can cost thousands. Look at total potential costs, not just premiums.

Not Checking If Your Doctors Are In-Network

"The plan covers my doctor" and "my doctor is in-network" are different things. Verify that your specific doctors, at their specific locations, are in the plan's network for 2025. Don't assume.

Forgetting About Prescription Drug Coverage

If you choose Original Medicare without Part D and later need prescriptions, you'll face a permanent late enrollment penalty. Always have drug coverage, even if you don't currently take medications.

Not Considering Future Health Needs

You're choosing Medicare at 65, but you'll have it for the rest of your life. Consider not just your current health, but what's likely as you age. Most people's healthcare needs increase over time.

Listening Only to Insurance Salespeople

Insurance agents earn commissions from the plans they sell. They may be knowledgeable and helpful, but their income depends on which plan you choose. Get information from multiple sources, including non-commissioned advisors.

For more on this topic, read our full guide on Medicare Enrollment Mistakes to Avoid.

Step-by-Step Plan Selection Process

Here's a practical process for help selecting a Medicare plan that fits your needs:

Step 1: List Your Doctors and Medications

Write down:

• Your primary care doctor's name and address
• All specialists you see regularly
• Hospitals you prefer or might need
• Every prescription medication (name, dosage, and frequency)

Step 2: Determine Your Budget

Decide how much you can afford monthly versus annually. Are you willing to pay higher premiums for predictability? Or do you prefer lower premiums and accept the risk of higher costs if you get sick?

Step 3: Check Medicare.gov Plan Finder

Go to Medicare.gov Plan Finder and enter your zip code. It will show all Medicare Advantage and Part D plans available in your area, with estimated costs based on your medications.

Step 4: Compare 3-5 Top Options

Don't try to compare every plan. Narrow down to 3-5 that fit your priorities and compare them on:

• Total estimated annual cost (premiums + out-of-pocket)
• Your doctors' network status
• Your medications' tier placement and costs
• Out-of-pocket maximum
• Star rating (quality measure)

Step 5: Read the Fine Print

Before enrolling, review:

• Prior authorization requirements: What services need pre-approval?
• Step therapy: Must you try cheaper drugs before the plan covers what you need?
• Referral requirements: Do you need referrals to see specialists?
• Network changes: Can the plan change its network mid-year?

Step 6: Enroll During the Right Period

Make sure you enroll during the correct enrollment period to avoid penalties and gaps in coverage. See our Medicare Enrollment Periods Guide for timing.

When to Get Professional Help

While this guide gives you the framework for help choosing a Medicare plan, some situations benefit from professional guidance.

Signs You Need Help

• You feel overwhelmed despite researching your options
• You have multiple chronic conditions requiring coordinated care
• You're transitioning from employer coverage, COBRA, or TRICARE
• You take expensive specialty medications
• You split time between multiple states
• You want to switch from Medicare Advantage to Medigap mid-year

Why Fee-Only Advisors Are Different

Most "Medicare help" comes from insurance agents who earn commissions. They may be helpful, but they have a financial incentive to recommend certain plans over others.

Fee-only Medicare advisors are paid directly by you for their time and expertise. They don't sell insurance, so they have no financial stake in which plan you choose. Their only goal is helping you find what's best for your situation.

What to Expect from a Medicare Consultation

A good Medicare consultation should:

• Review your complete health situation (doctors, medications, conditions)
• Understand your budget and priorities
• Explain all options objectively, including trade-offs
• Run cost comparisons for your specific medications
• Verify your doctors' network status in potential plans
• Give you a clear recommendation with reasoning
• Help you enroll if you choose

Learn more about our approach on our Medicare Consultant Services page, or schedule a free consultation to discuss your situation.