5 Smart Questions to Ask Before Choosing a Medicare Plan

Ken Parson

Choosing a Medicare plan is one of the most important decisions you’ll make for your health and financial well-being, especially as options continue to grow here in North Carolina. Whether you're enrolling for the first time or thinking about making a change during the Annual, Initial, or Special Enrollment Periods, asking the right questions now can save you from surprises later.

 

With dozens of Medicare Advantage plans, multiple Medigap policies, and various prescription drug options available for 2026, it's easy to feel overwhelmed. But with a little guidance and the right questions, you can narrow down the best fit for your unique needs.

 

Here are five key questions to ask before choosing your Medicare coverage:

 

1. What Will My Total Costs Be?

 

When comparing Medicare plans, it’s tempting to focus only on the monthly premium but that’s just the beginning. Be sure to also consider:

  • Deductibles (how much you pay before coverage kicks in)

  • Copayments and coinsurance (your share of costs for doctor visits, hospital stays, etc.)

  • The annual out-of-pocket maximum (for Medicare Advantage plans)

Medicare Advantage plans may have lower premiums but higher copays. Medigap plans, on the other hand, tend to cost more upfront but cover most out-of-pocket expenses. Original Medicare alone doesn’t cap your total spending, so understanding your total potential costs is key.

2. Are My Preferred Doctors and Hospitals in the Network?

 

If you have doctors or specialists you want to keep, double-check whether they’re in the plan’s network, especially if you’re considering a Medicare Advantage plan.

 

Provider networks can change from year to year, so don’t assume your doctor will always be included. And if you're looking at plans with limited regional coverage, make sure your preferred hospital or medical center participates as well.

 

For Medigap and Original Medicare, provider access is generally broader, but it’s still worth confirming any limitations based on your location and needs.

 

3. Do My Prescriptions Get Covered, and at What Cost?

 

Prescription drug coverage can vary widely between plans. Look carefully at the plan’s formulary (drug list) to make sure:

  • Your current medications are covered

  • They’re in a cost-effective tier (generic vs. brand-name)

  • Your preferred pharmacy is considered a preferred provider, which can impact what you pay

Even small differences in drug pricing or pharmacy networks can add up over time, so it pays to compare this detail closely.

 

4. What Extra Benefits Does This Plan Offer?

 

Medicare Advantage plans often bundle in extra benefits that Original Medicare doesn’t cover. Depending on the plan, these may include:

  • Dental and vision care
  • Hearing aids
  • Gym memberships (like SilverSneakers)
  • Over-the-counter allowances
  • Transportation to medical appointments
  • Telehealth and virtual care options

If any of these extras are important to your lifestyle or health needs, they may tip the scale when comparing two similar plans.

 

5. How Does This Plan Fit My Current and Future Health Needs?

 

Health needs can change, sometimes quickly. Consider how often you currently see doctors, specialists, or receive treatments. Do you anticipate more care in the next year?

 

It’s also wise to review how the plan’s benefits or costs might change from year to year. Medicare Advantage plans update their coverage annually, so what works this year might not be the best fit next year. That’s why reviewing your plan during each enrollment period is so important.

 

Need Help? Talk to a Local Medicare Expert You Can Trust

 

The right Medicare plan isn’t one-size-fits-all. Your health, budget, and preferences matter — and getting answers to these five questions can help you avoid costly mistakes.

 

At Triangle Medicare Solutions, we offer free, personalized help for Medicare beneficiaries across North Carolina. Whether you're reviewing your current plan or enrolling for the first time, we’ll walk you through your options and help you compare plans that truly meet your needs.

 

Don’t guess when it comes to Medicare. Contact Triangle Medicare Solutions today for expert support and confident coverage decisions.