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A worksheet for comparing Medicare Advantage plans

Color portrait of Mark Pabst By Mark Pabst

If you’re shopping for a Medicare Advantage (MA) plan, you probably have several options to choose from. So how do you find the plan that’s right for you?

The first step is understanding MA plans and the type of coverage they provide. One of the most important things to know is that all MA plans are offered by private insurance companies contracted with Medicare. By law, these plans must provide at least the same level of coverage that Medicare Part A and Part B, often called Original Medicare, provide. But many MA plans also provide additional benefits not included in Original Medicare.  

“Using a tool that helps you compare the different MA plans available is a great way to ensure the plan you choose will help you achieve your health goals.”

Individual MA plans can differ greatly based on elements like how much the plan costs, which doctors you can see and whether the plan includes special benefits like gym memberships or help paying for your over-the-counter medicines. Using a tool that helps you compare the different MA plans available is a great way to ensure the coverage you choose will help you achieve your health goals.

 

A worksheet to get you started


By downloading, printing and filling out our MA plan comparison worksheet, you can keep track of the most important elements of different MA plans as you do your research. Gathering the relevant information for the categories included in the worksheet will allow you to perform a side-by-side comparison of different plans. You can fill out the form while doing research on your own online, or you can work with an agent to help complete the worksheet. And if you already have coverage and are interested in seeing how it stacks up to other options, enter the relevant information from your current plan in the first column so you can easily compare it to other plans.

Below you’ll find a shortened example of what your completed worksheet may look like. If you’re not sure about the meaning of any words you come across while filling out the worksheet, see our Medicare glossary for helpful definitions.

And if you want to learn more about the different parts of Medicare, see our article about understanding Medicare.

Sample Medicare Advantage plan comparison worksheet (click to download a blank worksheet you can use to research MA plans available to you).  

 Sample Medicare Advantage plan comparison worksheet

Sample Medicare Advantage plan comparison worksheet

Please note that all information included in the sample worksheet below is for illustrative purposes only and does not represent actual plans.

Company
Plan name

Company 1
Sample plan 1

Company 2
Sample plan 2

Company 3
Sample plan 3

Company 4
Sample plan 4

Monthly plan premium

$0

$50

$0

$25

Medical deductible

$100 in network

 

$200 out of network

$100 in network

 

$500 out of network

$150 in network

 

$200 out of network

$100 in network

 

$250 out of network

Annual out-of-pocket maximum

$8,300 in network

 

$12,450 out of network

$7,000 in network

 

$12,450 out of network

$8,300 in network

 

$12,450 out of network

$8,300 in network

 

$12,450 out of network

Is my PCP in network?

Yes – Dr. Smith

No

No

Yes – Dr. Smith

Dental benefit?

Yes – Allowance of $1,000

No

Yes – Allowance of $500

Yes – Allowance of $1,000

Dental network requirement?

No

Yes

Yes

Yes

Eyewear benefit?

Yes – $185 every year for eyewear

Yes – $100 every year for eyewear

No

Yes – $150 every year for eyewear

Hearing aid benefit?

Yes – $0 for basic hearing aid

Yes – $10 for basic hearing aid

No

Yes – $0 for basic hearing aid

Allowance for over-the-counter items?

Yes – $50 every 3 months

No

No

Yes – $50 every 3 months

Notes

SilverSneakers® fitness

No preferred pharmacy in area

Includes acupuncture

Includes chiropractic services

Company
Plan name

Company 1
Sample plan 1

Monthly plan premium

$0

Medical deductible

$100 in network

 

$200 out of network

Annual out-of-pocket maximum

$8,300 in network

 

$12,450 out of network

Is my PCP in network?

Yes – Dr. Smith

Dental benefit?

Yes – Allowance of $1,000

Dental network requirement?

No

Eyewear benefit?

Yes – $185 every year for eyewear

Hearing aid benefit?

Yes – $0 for basic hearing aid

Allowance for over-the-counter items?

Yes – $50 every 3 months

Notes

SilverSneakers® fitness

Company
Plan name

Company 2
Sample plan 2

Monthly plan premium

$50

Medical deductible

$100 in network

 

$500 out of network

Annual out-of-pocket maximum

$7,000 in network

 

$12,450 out of network

Is my PCP in network?

No

Dental benefit?

No

Dental network requirement?

Yes

Eyewear benefit?

Yes – $100 every year for eyewear

Hearing aid benefit?

Yes – $10 for basic hearing aid

Allowance for over-the-counter items?

No

Notes

No preferred pharmacy in area

Company
Plan name

Company 3
Sample plan 3

Monthly plan premium

$0

Medical deductible

$150 in network

 

$200 out of network

Annual out-of-pocket maximum

$8,300 in network

 

$12,450 out of network

Is my PCP in network?

No

Dental benefit?

Yes – Allowance of $500

Dental network requirement?

Yes

Eyewear benefit?

No

Hearing aid benefit?

No

Allowance for over-the-counter items?

No

Notes

Includes acupuncture

Company
Plan name

Company 4
Sample plan 4

Monthly plan premium

$25

Medical deductible

$100 in network

 

$250 out of network

Annual out-of-pocket maximum

$8,300 in network

 

$12,450 out of network

Is my PCP in network?

Yes – Dr. Smith

Dental benefit?

Yes – Allowance of $1,000

Dental network requirement?

Yes

Eyewear benefit?

Yes – $150 every year for eyewear

Hearing aid benefit?

Yes – $0 for basic hearing aid

Allowance for over-the-counter items?

Yes – $50 every 3 months

Notes

Includes chiropractic services

 Sample Medicare Advantage plan comparison worksheet

Sample Medicare Advantage plan comparison worksheet

Please note that all information included in the sample worksheet below is for illustrative purposes only and does not represent actual plans.

Company
Plan name

Company 1
Sample plan 1

Company 2
Sample plan 2

Company 3
Sample plan 3

Company 4
Sample plan 4

Monthly plan premium

$0

$50

$0

$25

Medical deductible

$100 in network

 

$200 out of network

$100 in network

 

$500 out of network

$150 in network

 

$200 out of network

$100 in network

 

$250 out of network

Annual out-of-pocket maximum

$8,300 in network

 

$12,450 out of network

$7,000 in network

 

$12,450 out of network

$8,300 in network

 

$12,450 out of network

$8,300 in network

 

$12,450 out of network

Is my PCP in network?

Yes – Dr. Smith

No

No

Yes – Dr. Smith

Dental benefit?

Yes – Allowance of $1,000

No

Yes – Allowance of $500

Yes – Allowance of $1,000

Dental network requirement?

No

Yes

Yes

Yes

Eyewear benefit?

Yes – $185 every year for eyewear

Yes – $100 every year for eyewear

No

Yes – $150 every year for eyewear

Hearing aid benefit?

Yes – $0 for basic hearing aid

Yes – $10 for basic hearing aid

No

Yes – $0 for basic hearing aid

Allowance for over-the-counter items?

Yes – $50 every 3 months

No

No

Yes – $50 every 3 months

Notes

SilverSneakers® fitness

No preferred pharmacy in area

Includes acupuncture

Includes chiropractic services

Company
Plan name

Company 1
Sample plan 1

Monthly plan premium

$0

Medical deductible

$100 in network

 

$200 out of network

Annual out-of-pocket maximum

$8,300 in network

 

$12,450 out of network

Is my PCP in network?

Yes – Dr. Smith

Dental benefit?

Yes – Allowance of $1,000

Dental network requirement?

No

Eyewear benefit?

Yes – $185 every year for eyewear

Hearing aid benefit?

Yes – $0 for basic hearing aid

Allowance for over-the-counter items?

Yes – $50 every 3 months

Notes

SilverSneakers® fitness

Company
Plan name

Company 2
Sample plan 2

Monthly plan premium

$50

Medical deductible

$100 in network

 

$500 out of network

Annual out-of-pocket maximum

$7,000 in network

 

$12,450 out of network

Is my PCP in network?

No

Dental benefit?

No

Dental network requirement?

Yes

Eyewear benefit?

Yes – $100 every year for eyewear

Hearing aid benefit?

Yes – $10 for basic hearing aid

Allowance for over-the-counter items?

No

Notes

No preferred pharmacy in area

Company
Plan name

Company 3
Sample plan 3

Monthly plan premium

$0

Medical deductible

$150 in network

 

$200 out of network

Annual out-of-pocket maximum

$8,300 in network

 

$12,450 out of network

Is my PCP in network?

No

Dental benefit?

Yes – Allowance of $500

Dental network requirement?

Yes

Eyewear benefit?

No

Hearing aid benefit?

No

Allowance for over-the-counter items?

No

Notes

Includes acupuncture

Company
Plan name

Company 4
Sample plan 4

Monthly plan premium

$25

Medical deductible

$100 in network

 

$250 out of network

Annual out-of-pocket maximum

$8,300 in network

 

$12,450 out of network

Is my PCP in network?

Yes – Dr. Smith

Dental benefit?

Yes – Allowance of $1,000

Dental network requirement?

Yes

Eyewear benefit?

Yes – $150 every year for eyewear

Hearing aid benefit?

Yes – $0 for basic hearing aid

Allowance for over-the-counter items?

Yes – $50 every 3 months

Notes

Includes chiropractic services

About the author

Mark Pabst has worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.

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