Choosing the Right Medicare Advantage Plan: The Three Ps That Matter

Premiums may look enticing at $0, but seniors should weigh the true cost by focusing on Price, Providers, and Prescriptions.

By Matt Gerrell, senior healthcare executive with leadership experience as President of a regional health plan, and founder of Gerrell Collective, a Central Florida consulting firm specializing in healthcare strategy and growth.

Every fall, I met seniors who tell me the same story: “I picked the $0 premium plan because it looked like the best deal.” Months later, they’re shocked when the bills start piling up. Higher copays, out-of-network doctors, and expensive prescriptions they thought would be covered. The truth is, choosing a Medicare Advantage (MA) plan isn’t as simple as picking the cheapest option.

That’s why I’ve always taught seniors to look at the “Three Ps” of Medicare Advantage: Price, Providers, and Prescriptions. If you start with these three in order, you’ll avoid most of the costly surprises and find a plan which truly fits your needs.

Price: More Than Just a Premium

The first “P” is price. Many seniors gravitate toward plans advertising a $0 monthly premium. While that sounds attractive, the trade-off is often higher copays and coinsurance when you need care. For someone managing a serious illness, a plan with a $100 monthly premium could save thousands in drug and treatment costs by reducing out-of-pocket expenses.

Some Medicare Advantage plans include a Part B give-back benefit.  This means the Medicare Advantage plan pays part of the Medicare Part B premium. Effectively increasing Social Security checks (if it’s deducted there) or reducing the out-of-pocket premium if paid directly. Only a subset of MA plans offers this benefit (about one-third in 2025), and the amount can range from a few cents up to over $100 monthly. So while it may sound appealing, it's important to compare overall costs and coverage before choosing based solely on the give-back feature. Price is about the whole picture, not just the monthly bill.

Providers: Who You Can See Matters

The second “P” is providers. This is one of the most overlooked and most painful surprise seniors encounter. A low-cost plan may look great until you realize your preferred doctor, specialist, or hospital isn’t in the network. Medicare Advantage plans often limit choices to specific providers, so it’s critical to confirm your doctor and hospital are covered before signing up. A plan is only as good as the care you can access.

Prescriptions: Covering What Keeps You Healthy

The third “P” is prescriptions. Prescription drug coverage varies widely from plan to plan. If you rely on a life-saving medication, the cost differences can be dramatic depending on whether the drug is on the plan’s formulary and how it is tiered. Even a small change in coverage could mean hundreds of dollars a month. Reviewing your medications against each plan’s formulary is a must.

Putting It All Together

When selecting a Medicare Advantage plan, don’t be swayed by advertisements or shiny $0 premiums. Start with the Three Ps:

1. Look beyond the premium to understand the true cost of care.

2. Make sure your doctors and hospitals are in the network.

3. Double-check that your prescriptions are covered affordably.

The right Medicare Advantage plan might not be the cheapest on paper. The right plan is one which best fits your health needs, budget, and lifestyle. For seniors in Central Florida and beyond, taking the time to evaluate the Three Ps can make all the difference in your health and financial well-being.