How to Compare Medicare Advantage Plans During AEP 2026: Star Ratings, Networks, Formularies, and the Switch Playbook

The 2026 Medicare Annual Election Period (AEP) runs October 15 through December 7, 2026. Whatever you pick during those 54 days is your coverage for the entire 2027 calendar year, effective January 1. Roughly 33 million Americans are enrolled in Medicare Advantage in 2026, and about 70% of them will do nothing during AEP and be auto-renewed into the next-year version of their current plan. That is a decision, not the absence of one — and it is often the wrong decision, because plans reshuffle networks, formularies, and cost-sharing every year, and the 2027 version of a plan can look quite different from the 2026 version.

The good news: an hour of methodical shopping during AEP catches almost everything that could hurt you in the coming year. Doctors leaving the network. A prescription being dropped from the formulary or bumped to a higher tier. A Star Rating drop that signals service degradation. A supplemental benefit being cut. Or a materially better plan that has moved into your ZIP code. This guide is the plan-shopper checklist a Medicare broker uses, translated for you to do yourself in one sitting.

Every Medicare Advantage and standalone Part D plan is required by CMS to mail an Annual Notice of Change to enrollees by September 30, 2026. It shows exactly how the 2027 version of your current plan differs from the 2026 version. If yours has not arrived, the plan is required to make it available on the member portal — log in and download it.

The five ANOC pages that decide whether to stay or switch:

1. Monthly premium change. A $5 to $15 increase is normal. A $40+ increase is a shopping signal.
2. Maximum out-of-pocket (MOOP) change. A $500 jump in MOOP is a benefit reduction even if the premium is flat.
3. Formulary change table. Every dropped drug, every drug moved to a higher tier, every new prior authorization is listed. Cross-reference against your active prescriptions.
4. Provider network change. The ANOC does not list every terminated provider by name but names any hospital system changes and any major medical group departures.
5. Supplemental benefit change. The dental annual maximum, vision allowance, hearing aid benefit, OTC card, meal delivery, gym membership, and Part B giveback amount are all listed with 2026 vs 2027 values side by side.

CMS rates every Medicare Advantage contract and every standalone Part D contract on a 1 to 5 star scale each fall, based on approximately 40 measures across five domains: clinical quality (screenings, chronic condition management, follow-up), member experience (customer service, care coordination), complaints and member choice (voluntary disenrollment), member satisfaction survey results, and drug plan performance for MA-PD and PDP plans.

What the ratings mean in practice:

Two ways to use ratings when comparing plans: absolute rating (a 4-star plan is usually better service than a 3-star plan) and trend (a plan that dropped from 4.5 to 3.5 in one year is a warning; a plan that rose from 3 to 4 is often a real improvement). The Medicare Plan Finder shows both the current rating and the prior-year rating side by side.

Provider directories are wrong on the day they are published. CMS audits repeatedly find directory inaccuracy rates of 30% to 45%. That means one in three "in-network" listings for a plan you are shopping may actually be inaccurate — the doctor left the practice, the practice left the plan, the office is not accepting new patients, or the panel is closed for 2027.

The three-step verification process:

1. Directory search. On each plan's 2027 provider directory, look up every doctor, hospital, urgent care, imaging center, and physical therapy practice you use or expect to use. Note the contract number and plan benefit package (PBP) number displayed for the plan.
2. Phone verification. Call each provider's office. Ask them specifically: "Are you contracted with [plan name], contract [contract number], PBP [PBP number], as an in-network provider for 2027?" A yes on the plan brand alone is not enough — some plans have multiple PBPs and network configurations, and providers can be in one but not another.
3. Written confirmation for high-stakes providers. For a hospital, surgeon, oncologist, cardiologist, or any provider tied to a scheduled procedure, request written network confirmation from the plan. If you cannot get written confirmation, save a dated screenshot of the directory listing plus a call log.

A formulary change is the single most common source of "why did my costs jump so much?" complaints in January. A drug that was on tier 2 with a $10 copay in 2026 may be on tier 4 with a $95 copay in 2027 on the same plan. Or dropped entirely, in which case coverage requires a formulary exception request or a switch to a covered alternative.

Use the Medicare Plan Finder at medicare.gov as the source of truth. Enter your ZIP, then add each prescription by name, dose, and 30-day quantity. The Plan Finder shows every available plan sorted by expected annual drug cost including plan premium, deductible, and copays across the coverage year.

For each drug and each plan you are considering, verify:

• Is the drug on the 2027 formulary? If not, budget the cash price or plan the exception request. A dropped drug is often a plan disqualifier for anyone taking it regularly.
• What tier? Tier 1 (preferred generic) to tier 5 (specialty) — the higher the tier, the higher the copay or coinsurance.
• Utilization management flags. Prior authorization (PA), step therapy (ST), or quantity limits (QL) may delay the first fill in January. PA and ST are approvable with prescriber documentation, but that adds 3 to 14 days.
• Preferred pharmacy pricing. Many plans have a much lower copay at a preferred pharmacy (often a specific chain — CVS, Walgreens, Walmart, Costco) than at a non-preferred in-network pharmacy. Confirm the pharmacy you use is preferred, or plan to switch.

A $0 premium plan can cost you more than a $40 premium plan if the specialist copay is higher, the MOOP is higher, or your drug tiers are worse. The correct comparison is total expected out-of-pocket cost for the year, which equals: (12 × monthly premium) + expected medical copays across the plan's cost-sharing schedule + expected drug costs from the Plan Finder.

Anchor the medical side with a realistic count of expected visits:

Add the medical estimate to the Plan Finder's expected drug cost. If the estimated total exceeds the plan's MOOP, cap the medical side at the MOOP amount (Part D drug costs are separate and do not count toward MOOP; they have their own $2,100 cap in 2026, rising for 2027).

Medicare Advantage plans compete heavily on supplemental benefits — dental, vision, hearing, fitness, over-the-counter (OTC) allowances, meal delivery, transportation, and Part B premium givebacks. Marketing tends to lead with the biggest number available; your job is to quantify what you will actually use.

Realistic-use scoring for the major categories:

• Dental. A $1,000 annual maximum with cleanings but no basic/major coverage is worth roughly $250 in real value (two cleanings). A $2,500 annual maximum with 50% coverage on crowns, root canals, and dentures is worth $600 to $1,500 depending on need. Confirm the in-network dentist list before valuing dental.
• Vision. One exam plus a $200 to $400 frame allowance every 12 or 24 months is worth $150 to $350 in real value depending on prescription changes.
• Hearing aids. A $1,500-per-ear benefit against a $2,500-per-ear real cost saves about $3,000 for a member who is buying hearing aids this year, near zero for a member who is not.
• Part B premium giveback. A plan that credits $50 to $175 per month against your Part B premium is a direct-dollar benefit — $600 to $2,100 per year in cash flow. Verify by checking your Social Security award letter for the reduced Part B deduction after enrollment.
• OTC allowance. $25 to $150 per quarter delivered through a specific catalog or debit card. Real value if the catalog carries products you would buy anyway; near zero if the catalog is limited to items you would not use.
• Fitness (SilverSneakers, Renew Active, One Pass). Real value only if you will actually go. If you already have a gym membership you like and value, this is a duplicate benefit.
• Meal delivery. Usually limited to 10 to 28 meals after a hospital discharge. Valuable when triggered, near zero in a healthy year.

Prior authorization is the biggest hidden difference between Medicare Advantage plans. Original Medicare authorizes most services automatically; MA plans require PA for many services including some outpatient procedures, imaging, home health, skilled nursing facility stays, physical therapy beyond certain thresholds, and specialty drugs.

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) reshaped MA prior authorization starting January 1, 2026:

• Standard prior authorization decisions must be made within 7 calendar days of a complete request.
• Expedited prior authorization decisions must be made within 72 hours.
• Plans must publicly report PA metrics — average decision times, approval and denial rates, and appeal outcomes.
• Denial notices must include a specific reason and describe the appeal path.

When comparing plans, check the plan's publicly reported PA data (many plans link this from their transparency page or CMS lists it). A plan with a 15% initial denial rate and a 65% overturn rate on appeal is delivering worse service than a plan with a 6% denial rate and a 40% overturn rate — the first plan is denying more, and it is denying wrong more.

If a plan turns out to be a mistake in January, you are not stuck for the full year. Three safety nets:

You can enroll during AEP through medicare.gov (Plan Finder → Enroll), through the plan's own portal, by paper application mailed to the plan, or through a licensed broker. All routes produce identical enrollment records at CMS, but medicare.gov and the plan portal are usually fastest.

Within 10 business days of enrolling, verify:

1. You received a written or portal confirmation of enrollment with your effective date (January 1, 2027).
2. Your new member ID card arrived (usually within 3 weeks; some plans issue digital cards immediately).
3. Your old plan received a disenrollment notice for December 31, 2026, so you are not enrolled in two plans simultaneously.
4. Your pharmacy has your new plan on file so your first January fill runs correctly.
5. Your primary care physician's office and any specialists you have upcoming appointments with have your new plan on file.

If any of the five items above is missing on day 10, call the new plan's member services line, note the reference number, and ask for written confirmation of the enrollment record. Most enrollment errors are quickly correctable if caught in December; the same errors caught in January cause missed appointments, rejected pharmacy claims, and gaps in coverage.

Every state has a State Health Insurance Assistance Program (SHIP) that provides free, unbiased, one-on-one Medicare counseling. SHIP counselors are not brokers; they do not sell plans and are not paid commission. During AEP, SHIP counselors book up quickly, so schedule early. A 30-minute SHIP appointment is the highest-value validation of a preliminary plan choice — the counselor pulls up your ZIP code, your current plan, and your prescription list, and independently walks through the same comparison.

Find your local SHIP at shiphelp.org or call 1-877-839-2675. SHIP counselors are also the right first call for any coverage confusion, prior authorization dispute, or appeal navigation year-round.

1. Minutes 0–10. Read the ANOC. Note changes in premium, MOOP, formulary, network, supplemental benefits.
2. Minutes 10–25. Go to medicare.gov Plan Finder. Enter ZIP, prescriptions, and pharmacy. Sort by "Lowest Total Cost." Review top 5 plans.
3. Minutes 25–40. On each top-5 plan, check Star Rating, MOOP, doctor/hospital network coverage, formulary tier for each drug, and supplemental benefit fit.
4. Minutes 40–50. Phone-verify network status for your primary care doctor, top 2 specialists, and preferred hospital on the shortlist plan.
5. Minutes 50–55. If shortlist plan differs from current, book a SHIP counselor appointment for a sanity check.
6. Minutes 55–60. Enroll through medicare.gov or the plan portal. Save the confirmation.

The clock resets every year. AEP is your annual chance to correct a year-old plan choice — or confirm it is still right. Skipping the hour is the most expensive AEP decision most Medicare beneficiaries make.