Star ratings, plan summaries, mailers — none of them can answer the two questions that actually determine whether a plan works for you: is your doctor in the network, and is your medication covered the way you need it to be? Those two questions have to be checked by name, every time, because they change from plan to plan and from year to year.
Every plan sets its own network
Medicare Advantage plans each build their own network of doctors, specialists, and hospitals. Two plans that look similar on paper can include completely different sets of providers. A plan can be a great fit for your neighbor and a poor fit for you, simply because your cardiologist is in one plan's network and not the other's.
Checking a network isn't a one-time thing, either — networks can change from year to year, so a plan that included your doctor last year isn't guaranteed to include them going forward. That's part of why a review looks at current information rather than relying on what you remember from a previous enrollment.
Every plan sets its own formulary
The same is true for medications. Each plan — whether it's a standalone Part D plan or the drug coverage built into a Medicare Advantage plan — maintains its own formulary: the specific list of medications it covers, organized into tiers, often with rules like prior authorization or step therapy attached to certain drugs.
Two plans can cover the exact same medication completely differently. One might place a drug on a low-cost tier with no restrictions; another might require you to try a different medication first. Without checking your specific prescriptions against a specific plan's formulary, you're guessing.
Why general descriptions can't answer this
Star ratings measure things like customer service, preventive care usage, and member satisfaction across an entire plan's population. They're useful for some things, but they say nothing about whether your specific doctor is in-network or whether your specific medication is covered well. A five-star plan can still be a poor fit for your prescriptions, and a plan with a lower rating can still be the best fit for your situation.
How this plays out in a review
A plan review that starts with your doctors and medications works through this directly: your doctors get checked against each available plan's network, one by one, and your medications get checked against each plan's formulary, by name. What's left after that is a genuinely comparable picture of your actual options — not a generic summary that happens to leave out the two things that matter most to you.
Why this is worth rechecking, not just checking once
Networks and formularies aren't fixed forever — plans can adjust both from year to year, sometimes adding a doctor or medication, sometimes dropping one. A plan that lined up perfectly with your doctors and prescriptions at enrollment can look different a year or two later. That's why it's worth treating this as a periodic check-in rather than a one-time decision, especially if your doctors or medications have changed, or if you simply haven't looked at it in a while.
Questions about your own situation?
Free, no-obligation plan review — we start with your doctors and medications, checked by name.
Request my free plan review