Is your kitchen table buried under a mountain of Medicare mailers? If you’re helping a parent with their choices, you know how overwhelming it gets. You want to give the best advice, but every brochure promises the world. You don’t have to sort through it alone. An online tool like eHealth Medicare can bring order to the chaos, letting you compare plans based on what truly matters to your parent. This guide is for you—the trusted helper. We’ll show you how to clearly evaluate eHealth Medicare plans 2025 and find the right fit.
Key Takeaways
- Prioritize the 2025 plan changes: A new $2,000 cap on yearly prescription costs offers significant financial protection. When comparing plans, also look for enhanced telehealth, dental, and vision benefits to get the most value.
- Calculate the total cost, not just the premium: A plan’s true cost includes the deductible, copayments, and maximum out-of-pocket limit. A $0 premium plan might have higher costs elsewhere, so add everything up to find what truly fits your budget.
- Confirm your doctors and drugs are covered: A plan is only right for you if it includes your trusted providers and essential medications. Before enrolling, use the plan’s tools to check its network and drug list to prevent surprise bills and gaps in care.
How Can eHealth Help You Find a Medicare Advantage Plan?eHealth and How Does It Work for Medicare Advantage?
Think of Medicare Advantage plans as an all-in-one alternative to Original Medicare. And think of eHealth as a digital tool that helps you sort through your options. When you put them together, you get a straightforward way to find a plan that fits your life and your budget. Let’s walk through how it all works.
First, What Is a Medicare Advantage Plan?
First, let’s quickly cover what a Medicare Advantage plan is. Also known as Part C, these plans bundle your hospital coverage (Part A) and your medical coverage (Part B) into a single plan offered by a private insurance company. The best part for many people is that most Medicare Advantage plans include extra benefits you wouldn’t get with Original Medicare. This often means you get prescription drug coverage (Part D), along with dental, vision, and hearing care, all wrapped into one package. It’s a simple way to get comprehensive coverage without juggling multiple policies.
How eHealth Streamlines Your Plan Search
eHealth is an online marketplace that lets you compare insurance plans from different companies side-by-side. Using the platform is completely free for you because insurance companies pay eHealth when you sign up for a plan through their site. To get started, you just enter your ZIP code, and eHealth will show you a list of Medicare Advantage plans available in your area. From there, you can easily filter the results based on what’s most important to you, whether that’s the monthly cost, the plan type (like an HMO or PPO), the insurance company, or specific benefits.
Understanding eHealth: What You Need to Know
While eHealth can be a helpful starting point, it’s important to know how the platform works before you begin your search. It’s a tool, and like any tool, understanding its features and limitations is key to using it effectively. The platform is designed to simplify the process of finding a plan, but it doesn’t always show you the full picture. Knowing what eHealth is, what it shows you, and what it doesn’t, will empower you to make a more informed decision for yourself or your parent. This context is crucial for anyone looking to find a plan that truly meets their long-term healthcare needs and financial situation.
eHealth’s Role as a Private Broker
First and foremost, it’s essential to understand that eHealth is an insurance broker, not an insurance company. According to Medical News Today, this means its primary function is to help people find and purchase health insurance plans from various carriers. Think of it as a digital storefront that displays plans from different brands. While this can be convenient, it also means the company operates on a commission basis. Insurance companies pay eHealth when a customer enrolls in a plan through their website, which is a standard practice for brokers in the industry.
Incomplete Plan Selection
A significant limitation of using a platform like eHealth is that you won’t see every plan available to you. The site only displays plans from insurance companies it has a partnership with. This means your search results are curated and not a complete representation of the market. If you rely solely on eHealth, you could miss out on a plan from another carrier that might be a better fit for your specific health needs or budget. It’s a convenient but incomplete catalog of your options.
Potential for Biased Advice
Because eHealth is a private company that earns commissions from insurance carriers, it can be difficult to guarantee completely unbiased advice. While their agents may aim to be helpful, their recommendations could be influenced by their business relationships. This structure creates a potential conflict of interest. To get a truly objective view, it’s wise to compare the information you find on eHealth with other resources that don’t have the same financial incentives tied to your enrollment choice.
The Full Range of Products on eHealth
Despite its limitations, eHealth does offer a wide variety of insurance products. According to Healthline, you can use the platform to compare Medicare Advantage (Part C) plans, Medicare Supplement (Medigap) policies, and standalone Medicare Part D prescription drug plans. This allows you to explore different types of coverage in one place. Whether you’re looking for an all-in-one plan or supplemental coverage to go with Original Medicare, you’ll find options to consider on their site, making it a useful tool for initial research and comparison.
eHealth’s Industry Reputation
It’s also worth noting that eHealth has a solid reputation within the industry. The company holds an A+ rating from the Better Business Bureau, which reflects its commitment to resolving customer complaints and maintaining transparent business practices. This high rating suggests that while the platform has its structural limitations, it is generally considered a trustworthy and reliable business. For many users, this provides a level of confidence when using the site to explore their Medicare plan options and gather information before making a final decision.
Potential Downsides of Medicare Advantage Plans
Medicare Advantage plans are heavily advertised for their low premiums and extra benefits, but they aren’t the right fit for everyone. It’s crucial to look past the marketing and understand the potential drawbacks, especially if you or your parent has ongoing health concerns. These plans operate very differently from Original Medicare, with rules and restrictions that can lead to unexpected costs and challenges down the road. Some members have found that while their plan seemed great when they were healthy, it became a source of frustration once they needed significant medical care.
Challenges for Members with Significant Health Needs
One of the most common criticisms of Medicare Advantage plans is that they can be difficult for people with serious or chronic health conditions. As one Reddit user noted, these plans can seem “horrible” for those who are sick. This is often because MA plans manage care through networks and prior authorizations, which can create hurdles to getting specialized treatments. If you anticipate needing frequent medical attention or have a complex health history, the restrictive nature of an MA plan might become a significant barrier to receiving timely and appropriate care.
Risk of Care Denials and Network Limitations
With a Medicare Advantage plan, you are typically required to use doctors and hospitals within the plan’s network. Going out of network can result in much higher costs or no coverage at all. Furthermore, MA plans have been criticized for denying necessary medical care to control costs, sometimes using automated systems to make these decisions. This practice, known as prior authorization, means the insurance company must approve a service before it will cover it, which can delay or prevent you from getting the care your doctor recommends.
Feeling “Trapped” in a Plan
Some beneficiaries report feeling “trapped” in their Medicare Advantage plans, especially if their health declines. If you join an MA plan and later want to switch to Original Medicare and a Medigap policy, you might not be able to. In most states, insurance companies can deny you a Medigap policy based on your health history if you’re outside your initial enrollment period. This means if you develop a health condition while on an MA plan, you could be stuck in that plan without the option to switch to more flexible coverage.
Unbiased Alternatives for Comparing Medicare Plans
Given the limitations of private marketplaces and the complexities of Medicare Advantage plans, it’s smart to consult other resources before making a decision. Relying on a single source of information, especially one with a financial stake in your choice, can leave you with an incomplete picture. Fortunately, there are several free and unbiased alternatives available that can provide a comprehensive look at all your options. Using these resources will help you feel confident that you’ve chosen the best possible plan for your unique circumstances.
Using the Official Medicare.gov Plan Finder
The most reliable and comprehensive tool for comparing plans is the official Medicare website. You can visit medicare.gov/plan-compare to see all of your Medicare options in one place. Unlike private sites, the government’s Plan Finder tool shows every single Medicare Advantage and Part D plan available in your area, not just those from partner companies. This allows for a truly unbiased comparison based on costs, coverage, and quality ratings, ensuring you have all the information you need to make a well-rounded decision.
Getting Help from Your State Health Insurance Assistance Program (SHIP)
For personalized, free, and impartial advice, you can contact your local State Health Insurance Assistance Program (SHIP). SHIPs are federally funded programs that provide counseling to Medicare beneficiaries in every state. The counselors are trained volunteers who are not affiliated with any insurance company, so their guidance is completely objective. They can help you understand your specific options, check your eligibility for assistance programs, and answer any questions you have about the enrollment process. This is an invaluable resource for anyone feeling overwhelmed by their choices.
Working with an Independent Insurance Broker
Another excellent option is to work with a licensed independent insurance broker. Unlike agents who work for a single company, independent brokers represent multiple insurance carriers. This allows them to offer you a wide range of plans and provide personalized recommendations based on your needs, not a sales quota. At The Big 65, this is exactly what we do. We are licensed in 33 states and help our clients compare Medicare Supplement, Medicare Advantage, and Part D plans from many different companies to find the perfect fit.
Considering an Alternative: Medicare Supplement (Medigap)
If the potential downsides of Medicare Advantage plans give you pause, it’s worth exploring another path: Original Medicare paired with a Medicare Supplement plan, also known as Medigap. This combination is often preferred by individuals who want more predictability in their healthcare costs and greater freedom in choosing their doctors. While Medigap plans have a monthly premium, they can save you a significant amount of money in out-of-pocket costs if you need frequent medical care. It’s a different approach to coverage that prioritizes flexibility and financial protection.
How Medigap Works with Original Medicare
Medigap plans are designed to fill the “gaps” in Original Medicare. After Medicare pays its share of the costs for a covered service, your Medigap policy steps in to cover some or all of the remaining expenses, such as your deductibles, copayments, and coinsurance. This means you have very few, if any, out-of-pocket costs when you visit the doctor or hospital. A key benefit is that you can see any doctor or specialist in the U.S. that accepts Medicare, with no network restrictions or referral requirements.
A Look at Top-Rated Medigap Companies
Many highly-rated insurance companies offer Medigap plans, and the best one for you will depend on factors like cost, customer service, and plan availability in your state. NerdWallet recently reviewed some of the top companies based on these criteria, providing a helpful overview of what to look for. While premiums can vary, the benefits for each standardized plan (e.g., Plan G or Plan N) are the same across all companies. This makes it easier to compare your options based on price and company reputation.
AARP/UnitedHealthcare
AARP/UnitedHealthcare is often highlighted for its strong performance and high customer satisfaction. The company received top marks from NerdWallet for having very few customer complaints relative to its size. It also offers a wide variety of plan types, giving you plenty of options to choose from. For those who value brand recognition and a long history of positive member experiences, AARP/UnitedHealthcare is a leading contender in the Medigap market and is available in all 50 states.
Mutual of Omaha
Mutual of Omaha is another top-rated company, particularly known for its competitive pricing and household discounts. If you live with a spouse, partner, or even a roommate, you may be eligible for a significant discount on your monthly premium—often up to 12%. This can make their already affordable plans even more attractive. The company has a long-standing reputation for financial stability and reliable customer service, making it a popular choice for Medigap coverage.
State Farm
While perhaps best known for auto and home insurance, State Farm also offers Medigap policies with exceptionally high customer satisfaction. According to NerdWallet’s analysis, State Farm has a very low number of consumer complaints for its Medigap plans, which indicates that its members are generally happy with the service they receive. If responsive customer support and a hassle-free experience are high on your priority list, State Farm is definitely a company worth considering for your supplemental coverage.
What to Look for When You’re on eHealth
Once you see the list of plans, it’s time to zero in on the details. Pay close attention to the plan’s Star Ratings, which are official scores from Medicare ranging from 1 to 5 stars. A 5-star rating indicates the highest quality. Next, and this is crucial, use the tool to check if your specific prescription drugs are covered and what your copayments will be. Finally, review the extra benefits. Does the plan offer dental coverage that fits your needs? What about a gym membership or an allowance for eyeglasses? Focusing on these key areas will help you find a plan that truly works for you.
What’s Changing with Medicare Advantage Plans in 2025?
Medicare Advantage plans are always changing to better fit what you need, and the plans for 2025 are bringing some really positive updates. Think of it as an annual tune-up, where insurance companies refine their offerings based on feedback from members just like you. This year, the focus is on making healthcare more convenient, comprehensive, and affordable. You’ll see improvements in how you can access care from home, better coverage for essential services like dental and vision, and new support for mental wellness. Perhaps the most significant change is a new cap on prescription drug costs, which will provide a much-needed financial safety net for many. These updates are designed to support your overall health and well-being, making it easier to get the care you need, when you need it.
Expect More Telehealth Options
Getting to the doctor’s office isn’t always easy. That’s why more Medicare Advantage plans are expanding their telehealth services, letting you connect with healthcare providers from the comfort of your home. With a computer, tablet, or smartphone, you can have a virtual visit with your doctor, consult a specialist, or even get a prescription refilled without dealing with traffic or waiting rooms. This is especially helpful if you have mobility issues or live a long way from your providers. Many plans are making it simple to schedule and attend these appointments, ensuring you can get timely medical advice whenever you need it.
Improved Dental, Vision, and Hearing Benefits
One of the main reasons people choose Medicare Advantage is for the extra benefits that Original Medicare doesn’t cover. For 2025, many plans are making their dental, vision, and hearing coverage even better. This is great news because taking care of your teeth, eyes, and ears is a huge part of your overall health. You might find plans with lower copays for routine dental cleanings, more generous allowances for eyeglasses or contact lenses, and better coverage for hearing aids. These additional benefits can save you a lot of money on essential care that helps you stay healthy and engaged in life.
New Support for At-Home Care and Rides
Sometimes, the biggest hurdles to staying healthy have nothing to do with medical treatments. They’re about the practical challenges of daily life. Recognizing this, some Medicare Advantage plans are now offering benefits that provide help right where you need it. This can include services that assist with at-home care, giving you a hand with daily activities so you can continue to live independently. Other plans offer transportation to medical appointments, so you never have to worry about how you’ll get to your doctor or pharmacy. These thoughtful benefits are designed to address the real-world needs of members.
A Greater Focus on Wellness and Mental Health
Your mental health is just as important as your physical health, and Medicare Advantage plans are increasingly reflecting that. There is a growing emphasis on including strong mental health and wellness benefits. This means you can find plans with better coverage for counseling, therapy sessions, and other mental health services, making it easier to get the support you need. Beyond that, many plans continue to offer wellness perks like gym memberships, fitness classes, and other programs designed to keep you active and feeling your best. These wellness benefits are there to support your total well-being, both mind and body.
What to Know About Prescription Drug Costs
This is a game-changer for anyone with high medication costs. For the first time, Medicare Advantage plans that include drug coverage will have a $2,000 annual cap on out-of-pocket prescription costs. This means that once you’ve spent $2,000 of your own money on covered drugs in a year, you won’t pay anything more for them for the rest of the year. This new rule provides incredible financial protection and peace of mind. You no longer have to worry about unpredictable or sky-high medication bills. This limit on prescription drug costs is a significant step toward making necessary medications more affordable for everyone.
Breaking Down the Costs of a 2025 Medicare Plan
Figuring out the cost of a Medicare Advantage plan can feel like trying to solve a puzzle. It’s about more than just the monthly bill. To get a clear picture of what you’ll actually spend, you need to look at all the pieces together: the premium, the deductible, and your out-of-pocket maximum. A plan with a $0 monthly premium might look like the best deal at first glance, but it could have higher costs when you actually go to the doctor or pick up a prescription. Thinking about the total cost helps you find a plan that truly fits your budget and your health needs, so you can avoid any financial surprises down the road.
What You’ll Pay in Monthly Premiums
The monthly premium is the fixed amount you pay to the insurance company to keep your plan active. It’s the most straightforward cost, but it’s only one part of the equation. Many Medicare Advantage plans attract members with a $0 premium, which is always tempting. However, it’s important to remember what that premium covers. Many plans bundle in extra benefits like prescription drug coverage (Part D), as well as dental, vision, and hearing care. A plan with a small monthly premium might offer more robust coverage for the services you use most, making it a better value in the long run. When you compare Medicare Advantage plans, look at the premium alongside the benefits to see the full picture.
Understanding Your Annual Deductible
A deductible is the amount of money you have to pay for your covered health care services before your insurance plan starts to pay. Think of it as your share of the costs at the beginning of the year. For example, if your plan has a $300 deductible, you’ll pay the first $300 of your medical bills. After that, your plan’s cost-sharing features, like copayments and coinsurance, kick in. It’s important to keep an eye on this number, as a recent eHealth analysis shows the average deductible for Medicare Advantage plans jumped from $132 in 2024 to $315 in 2025. Budgeting for this upfront cost can help you manage your expenses throughout the year.
The Trend of Lower Premiums vs. Higher Deductibles
It’s easy to be drawn in by a plan with a low or even $0 monthly premium—it feels like an obvious win. However, there’s a growing trend you should be aware of: many of these plans come with higher deductibles. This means that while your parent might pay very little each month, they could be responsible for a much larger amount out-of-pocket when they actually need medical care. This trade-off highlights why it’s so important to calculate the total cost of a plan, not just the monthly bill. A plan that seems like the most affordable choice at first glance might lead to higher expenses throughout the year, so be sure to weigh the premium against the deductible to find a true financial fit.
What Is an Out-of-Pocket Maximum?
The maximum out-of-pocket (MOOP) is one of the most important features of a Medicare Advantage plan because it acts as a financial safety net. This is the absolute most you will have to pay for covered medical services in a single year. Once you’ve spent enough on deductibles, copayments, and coinsurance to reach your plan’s MOOP, the plan pays 100% of the cost for your covered services for the rest of the year. This protects you from overwhelming medical bills if you have a serious illness or accident. Knowing this number is essential for understanding your financial limits and gives you peace of mind that there’s a cap on your healthcare spending.
How to Calculate Your Total Healthcare Costs
To find your true healthcare costs, you have to look beyond the monthly premium. A $0 premium plan can be appealing, but it’s not the whole story. Your real cost is a combination of several factors: the monthly premium, the annual deductible, your copayments (fixed fees for visits or services), and your coinsurance (a percentage of the cost you pay for a service). All of these costs add up until you hit your maximum out-of-pocket limit. When comparing plans, think about how often you expect to see a doctor or need prescriptions. A low-premium plan might have higher copayments, which could cost you more if you need frequent care.
Top Medicare Advantage Providers on eHealth for 2025
When you start browsing on eHealth, you’ll notice a lot of familiar names. While there are many insurance companies to choose from, a handful of major providers consistently offer a wide range of plans across the country. Getting to know the key strengths of each one can help you narrow down your options and focus on the plans that best fit your needs. Let’s look at some of the top providers you’ll find on the platform.
Humana
Humana is a popular choice, and for good reason. Many of their plans include a “Part B Giveback” benefit, which is a feature that can help lower your monthly expenses by reducing your Medicare Part B premium. According to NerdWallet, over 60% of Humana’s plans offer this giveback feature. With plans available in 48 states, there’s a good chance you can find a Humana plan in your area. If keeping your monthly costs predictable is a top priority, looking into Humana’s offerings is a great place to start.
UnitedHealthcare
If you’re concerned about being able to see specific doctors or specialists, UnitedHealthcare might be the right fit for you. They are known for having the largest network of doctors and hospitals, with over one million providers participating. This extensive network gives you incredible flexibility and can provide peace of mind that you’ll have access to care when you need it. UnitedHealthcare offers plans in 49 states and Washington, D.C., making it one of the most widely available Medicare Advantage providers.
Aetna
For those who prioritize quality, Aetna stands out with consistently high ratings from Medicare. Nearly eight out of ten of their plans have earned a rating of 4 stars or higher, which signals a high level of member satisfaction and quality of care. These ratings are based on factors like customer service and how well the plan helps members stay healthy. Choosing a highly-rated plan can be a smart way to ensure you’re in good hands. Aetna offers plans in 44 states, so they are another strong contender for many beneficiaries.
Kaiser Permanente
Kaiser Permanente operates a bit differently from other providers. They are well-known for their integrated care model, which means your health plan, doctors, hospitals, and sometimes even your pharmacy are all part of the same system. This approach can lead to better-coordinated care because all your providers can easily communicate and share information about your health. If you value a streamlined healthcare experience where everything is connected, a Kaiser Permanente plan could be an excellent choice.
Blue Cross Blue Shield
Blue Cross Blue Shield (BCBS) is a federation of independent, locally operated companies, which means their plan offerings can vary significantly by state. This structure allows them to offer a diverse array of plans tailored to local communities. BCBS is generally recognized for having strong customer service and extensive provider networks. Because of their local focus, they are often a reliable option for beneficiaries who want a plan that understands the healthcare landscape in their specific area.
What Do Medicare Advantage Plans Actually Cover?
Once you have a handle on the costs, it’s time to look at what you get for your money. The benefits are the heart of any health plan, and with Medicare Advantage, there’s a lot to consider. These plans are designed to be all-in-one solutions, bundling different types of coverage together. This can make managing your health care much simpler than juggling multiple parts of Original Medicare. Think of it as getting all your core health needs covered under one roof, often with some valuable extras included. Let’s break down what you can typically expect to find in a 2025 Medicare Advantage plan on eHealth.
What Core Medical Services are Covered?
At their core, Medicare Advantage plans, also known as Part C, provide a straightforward way to get your essential medical coverage. These plans combine your hospital insurance (Part A) and your medical insurance for doctor visits (Part B) into a single, consolidated plan. This means that everything from a hospital stay to a routine check-up with your primary care physician is handled by one insurance provider. For many people, this bundling is a welcome change from Original Medicare, where you have separate parts for different services. It simplifies your paperwork and gives you one point of contact for all your main healthcare questions and claims, making the whole process feel much more manageable.
How Prescription Drug Coverage Works
One of the biggest draws of Medicare Advantage is that most plans include prescription drug coverage, or Part D. This is a significant benefit, as Original Medicare does not cover most outpatient prescription drugs. When a Medicare Advantage plan includes this coverage, it’s often referred to as an MA-PD plan. Having your medical and drug benefits in one plan means one less card to carry and one less premium to worry about. When you’re comparing plans on eHealth, it’s incredibly important to check the plan’s formulary—that’s the list of covered drugs—to make sure your specific medications are included. This simple step can save you from unexpected costs at the pharmacy down the road.
Don’t Forget About the Extra Perks
This is where Medicare Advantage plans really shine. Beyond covering hospital stays, doctor visits, and prescriptions, many plans offer a host of additional perks that Original Medicare doesn’t. Think of benefits like routine dental cleanings, eye exams for new glasses, and hearing aid coverage. These are some of the most popular extras, and they can add up to significant savings over the year. Many plans also include wellness programs like gym memberships, transportation to medical appointments, and even meal delivery services after a hospital stay. Because eHealth offers various types of insurance, you can easily compare these added benefits side-by-side to find a plan that truly supports your overall health and lifestyle.
Why Your Plan’s Network Matters
Before you commit to a plan, you need to understand its provider network. Most Medicare Advantage plans use a network of doctors, hospitals, and specialists. The two most common types of plans are HMOs and PPOs. An HMO, or Health Maintenance Organization, generally requires you to use providers within its network for your care to be covered. A PPO, or Preferred Provider Organization, offers more flexibility, allowing you to see out-of-network doctors, though you’ll usually pay more for it. It is absolutely essential to check that your trusted doctors and preferred hospitals are in the plan’s network before you enroll. This ensures you can continue receiving care from the providers you know and trust without facing unexpected bills.
Comparing eHealth Medicare Plans 2025: A Step-by-Step Guide
Once you’ve entered your information on eHealth, you’ll see a list of available plans. It can feel like a lot to take in, but the platform has built-in tools designed to help you sort through the options and find what truly matters. Think of it as a checklist. By focusing on a few key areas, you can confidently compare Medicare Advantage plans and find the one that fits your life. Let’s walk through exactly what to look for.
What Do the Star Ratings Mean?
You’ll notice that each plan has a star rating. These aren’t just customer reviews; they are official ratings from Medicare itself. The system scores plans from one to five stars, with five being the best. These ratings are a quick way to gauge a plan’s overall quality and performance. A plan with a higher star rating generally has a better track record with member satisfaction, customer service, and managing chronic conditions. While a five-star plan is great, don’t automatically dismiss a four-star plan if it meets your other needs, like covering your specific doctors and prescriptions.
How to Check if Your Doctor is In-Network
This step is crucial. A plan might look perfect on paper, but it won’t do you much good if your trusted doctor doesn’t accept it. Before you get too attached to a plan, you must confirm that your doctors are in its network. Use eHealth’s tool to search for your primary care physician, any specialists you see regularly, and the hospitals you prefer. If they are “in-network,” it means they have an agreement with the insurance company to provide care at a lower cost to you. Seeing an out-of-network doctor can lead to much higher bills or the plan not covering the visit at all.
Confirming Your Prescriptions Are Covered
Just as important as checking your doctors is verifying your drug coverage. This is a big one. A plan’s list of covered drugs is called a formulary, and it can change every year. You need to enter your specific prescription drugs to see if they are covered and, just as importantly, how much they will cost you. Look at the copay for each medication and see which “tier” it falls into, as this determines your price. Neglecting this step can lead to expensive surprises at the pharmacy, so take the time to check your drug coverage carefully for every plan you consider.
How to Compare Plans by Total Cost
The monthly premium is the first number most people see, but it’s only one part of the story. To understand what you’ll actually spend, you need to look at the total picture. Your real cost depends on the monthly premium, the deductible (what you pay first), copayments (fixed fees for visits), coinsurance (a percentage of the cost), and the maximum out-of-pocket limit. A plan with a $0 premium might have a high deductible or copays. The out-of-pocket maximum is especially important, as it’s the most you would have to pay for covered services in a year, protecting you from catastrophic costs.
Ready to Enroll? Here Are the Key Dates and Steps
Getting your Medicare Advantage plan set up is a straightforward process once you know what to expect. It really comes down to marking your calendar with a few key dates, gathering some information ahead of time, and knowing where to turn if you have questions. Think of it as a simple project with a few clear steps. By breaking it down, you can feel confident as you find and enroll in the right plan for your needs. Here’s everything you need to know to get started.
Mark Your Calendar with These Enrollment Deadlines
Timing is everything when it comes to Medicare. The most important period to know is the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. This is your main opportunity to join, switch, or drop a Medicare Advantage plan. If you’re happy with your current plan, you don’t have to do anything, but it’s always a good idea to review your options since benefits and costs can change. There are other times you can enroll, such as when you first become eligible for Medicare. You can learn more about the different Medicare enrollment periods to see which one applies to you.
What Paperwork Do You Need?
Before you sit down to compare plans or apply, you’ll save yourself a lot of time by having a few things ready. It’s nothing complicated, just some basic information that will make the process go smoothly. Have your red, white, and blue Medicare card handy, as you’ll need your Medicare number and the dates your Part A and Part B coverage started. You should also make a current list of all your doctors and specialists, along with a separate list of your prescription medications and the dosages. This information is essential for using eHealth’s tools to confirm that your preferred doctors are in-network and your drugs are covered by the plans you’re considering.
A Step-by-Step Guide to Applying Online
Applying for a plan on a platform like eHealth is designed to be user-friendly. Once you’ve compared your options and found a plan that fits your needs, you can typically apply directly on the website. The online application will guide you through each section, asking for the personal information you’ve already gathered. You’ll enter your Medicare details, confirm your personal information, and answer a few questions to finalize your enrollment. If you get stuck at any point, remember that help is just a click or a call away. The goal is to make the process as seamless as possible, so don’t hesitate to use the available support.
How to Get Help from a Licensed Agent
You don’t have to do this alone. If you feel overwhelmed by the options or just want to talk through your decision with an expert, you can connect with a licensed agent. On eHealth, you can speak with someone by phone or through an online chat for personalized help. An agent can answer your specific questions, verify that a plan meets your needs, and ensure your application is submitted correctly. Working with an independent licensed agent can provide an extra layer of confidence, as they can offer objective guidance to help you find a plan that truly works for you, your health, and your budget.
How to Choose the Right Medicare Advantage Plan for You
Picking a Medicare Advantage plan can feel like a huge decision because it is. But you don’t have to feel lost in the details. The best way to find the right fit is to break it down into a few manageable steps. By looking closely at your health, your budget, and the specifics of each plan, you can make a choice that you feel good about. Let’s walk through exactly what to look for.
Start by Looking at Your Health Needs
First, take a moment to think about your unique health situation. Are you managing any chronic conditions? How often did you see a doctor or specialist last year? Make a list of all your prescription medications, including the dosage. This information is critical because you’ll want a plan that covers your specific needs without a hitch. A plan that works perfectly for your neighbor might not cover your essential medications or include your trusted cardiologist. Getting this personal health inventory down on paper first will make comparing your Medicare Advantage plan options much more straightforward.
Match Your Budget to the Right Plan
A $0 monthly premium can be very tempting, but it doesn’t tell the whole story of what you’ll actually pay. To understand the true cost, you need to look at the complete picture. This includes the deductible (what you pay before the plan kicks in), copayments for doctor visits, and coinsurance for services. Also, pay close attention to the plan’s maximum out-of-pocket limit, which is the most you’d have to pay in a year. A plan with a low premium might have higher copays, which could cost you more in the long run if you visit the doctor often. Thinking about your total potential healthcare costs helps you find a plan that truly fits your finances.
Double-Check the Provider Network
Having a plan that includes your preferred doctors, specialists, and hospitals is essential for continuity of care and avoiding surprise bills. Never assume your doctor is covered. Insurance companies can and do change their networks, so it’s important to verify this every year. The best way to be certain is to use the plan’s provider directory and then call your doctor’s office directly to confirm they accept the specific plan you’re considering. Taking this extra step provides peace of mind and ensures you can keep the healthcare team you trust. You can also use the official Medicare Plan Finder to check networks.
Read the Fine Print: Rules and Restrictions
Every plan operates by its own set of rules. It’s important to understand these before you enroll to avoid headaches later. For instance, some plans require you to get a referral from your primary care doctor before you can see a specialist. Others may require prior authorization for certain procedures or medications, meaning the insurance company has to approve the service beforehand. You can find all of this information in the plan’s “Summary of Benefits” and “Evidence of Coverage” documents. Reading these details helps you understand exactly how to use your plan, so you’re fully prepared. If the fine print feels overwhelming, getting guidance from a licensed insurance agent can make all the difference.
Related Articles
- How Much Do Medicare Advantage Plans Cost in 2025?
- eHealth Medicare: Your Guide to Medicare Advantage Plans
- Compare Medicare Advantage Plans on eHealth (2025)
- Your Guide to Medicare Advantage Plans in 2025
- 2025 Medicare Advantage Explained | Big 65 Clarity
Frequently Asked Questions
Do I have to pay to use eHealth or get help from a licensed agent? No, you do not. Using online tools like eHealth to compare plans is completely free for you. Likewise, speaking with a licensed agent to get personalized guidance comes at no cost. These services are paid by the insurance companies through commissions when a person enrolls in a plan. This allows you to get expert help and access to comparison tools without worrying about hidden fees.
What if my favorite doctor isn’t in a plan’s network? This is a common and important concern. If you find a plan you like but your doctor isn’t in its network, you have a choice to make. You could look for a different plan that does include your doctor, which is often the preferred route. Alternatively, if the plan’s benefits are significantly better, you might consider if you’re willing to switch to a new doctor who is in the network. Some PPO plans may offer partial coverage for out-of-network care, but it’s crucial to understand those higher costs before committing.
With all these details, what’s the single most important thing to check when comparing plans? It’s less about a single thing and more about a personal balance of three key areas. The right plan for you is one that covers your essential prescriptions, includes your trusted doctors and hospitals in its network, and has a total cost structure that fits your budget. A plan is only a good fit when it works for you across all three of these critical areas, so it’s best to check each one carefully.
I’m happy with my current plan. Do I really need to review it every year? Yes, it’s a very good idea to review your plan annually during the Annual Enrollment Period. Insurance companies can and do make changes to their plans every year. This means your plan’s list of covered drugs, its network of doctors, and its costs—like premiums and copayments—can all be different next year. A quick review ensures your plan still meets your needs and that you aren’t missing out on a new option that might be a better fit.
How does the new $2,000 cap on prescription drug costs actually work? This new rule is a fantastic financial protection. For any Medicare Advantage plan that includes prescription drug coverage, there is now a $2,000 annual limit on what you have to pay out-of-pocket for your covered medications. Once your spending on deductibles and copayments for your drugs reaches that $2,000 mark in a year, you will pay nothing more for your covered prescriptions for the rest of that year.