This is the least glamorous guide here and probably the most useful. Two checks, done properly, eliminate most of the bad outcomes in Medicare plan selection.
Check the drugs first
Price your actual medication list, not the premium. Medicare’s Plan Compare tool lets you enter each prescription with its dosage and the pharmacy you use, and it will show the estimated annual cost across the plans available in your ZIP code.
What to look for, in order:
- Is every drug on the formulary at all? A drug that is not covered is not just expensive; what you spend on it does not count toward the Part D out-of-pocket cap.
- What tier is each drug on? The same drug on a different tier can change the annual total substantially.
- Are there restrictions? Prior authorisation, step therapy and quantity limits all mean the drug is covered conditionally.
- Does the pharmacy matter? Preferred pharmacies cost less in many plans. The same plan can show two different annual totals depending on where you fill.
Do this every year. A plan that was right last year can move a drug between tiers for the new plan year, and the Annual Notice of Change your plan sends in September is where that is disclosed.
Then check the doctors
If you are considering a Medicare Advantage plan, the network is a hard constraint, and the only reliable confirmation is from two directions: the plan’s own current directory, and the practice itself.
Ask the practice a specific question. Not “do you take Medicare” — almost everyone does — but “are you in network for this named plan for next year?” Directories go out of date and a practice can leave a network mid-year.
Medicare’s Care Compare tool is the place to check hospitals, skilled nursing facilities, home health agencies and dialysis facilities, which matter as much as the physician list if you have a condition that may need them.
If you are in Original Medicare instead
The network question largely disappears: any provider who accepts Medicare will see you. The drug check does not disappear — it becomes the whole of the exercise, because your stand-alone Part D plan is the only thing you are choosing.
The question to ask a provider in Original Medicare is whether they accept assignment, which determines whether they can bill you above the Medicare-approved amount.
The four mistakes this prevents
- Choosing on premium. A $0-premium plan with your drug on a high tier can cost more over the year than a plan with a premium.
- Assuming last year carries over. Formularies, tiers and networks are all reset for the new plan year.
- Checking the doctor but not the hospital. The physician can be in network while the facility they admit to is not.
- Forgetting the drugs you do not take yet. If a prescription is likely in the next year, check it now, while you can still choose.
Also on this site
Dated coverage of this topic, where the figures move year to year:
Frequently asked questions
Where do I check whether my drugs are covered?
Medicare’s Plan Compare tool at medicare.gov/plan-compare. Enter each prescription with its dosage and your pharmacy, and it will show estimated annual costs for the plans available in your ZIP code.
Is the plan directory enough to confirm my doctor is in network?
No. Confirm from both directions — the plan’s current directory and the practice itself — and ask specifically whether they are in network for that named plan for the coming year. Directories go out of date.
Do I need to do this every year?
Yes. Formularies, drug tiers and provider networks are all set for a plan year, and a plan that suited you last year can move one of your drugs to a different tier for the next. Your Annual Notice of Change in September is where the changes are disclosed.
Does the pharmacy I use change the price?
Often, yes. Many plans have preferred pharmacies where cost sharing is lower, so the same plan and the same drug list can produce two different annual totals depending on where you fill the prescription.
Sources
- Find health & drug plans — Medicare.gov · read 2026-10-19
- Find providers & services — Medicare.gov · read 2026-10-19
- Medicare drug coverage (Part D) costs — Medicare.gov · read 2026-10-19
This guide explains published rules and figures, with the source for each one. It is not advice about your own situation.