How to Choose a Medicare Advantage Plan That Covers Your Medications

When you’re exploring Medicare Advantage prescription coverage, it’s easy to feel buried in details—formularies, copays, tiers, networks, and endless plan names. But here’s the truth: the right plan can make all the difference between smooth, affordable access to your medications and a year of unexpected costs and headaches.

At Senior Insurance Quote, we specialize in helping Illinois seniors navigate these exact choices. Whether you’re new to Medicare or thinking of switching plans, here’s how to make sure your prescriptions stay covered and your budget stays balanced.

Step 1: Check the Formulary

Each Medicare Advantage Plan includes a formulary, or list of covered drugs. Think of it as a master menu—if your medication isn’t on it, you may have to pay the full retail price or switch to an alternative.

When comparing plans, always start here. Search the plan’s online formulary or ask your licensed insurance agent to help verify whether your current prescriptions are included and at what tier. Drugs are usually grouped by “tiers,” and each tier comes with its own copay or coinsurance level.

For example:

• Tier 1 (Preferred Generic): Lowest cost

• Tier 2 (Generic): Low cost

• Tier 3 (Preferred Brand): Moderate cost

• Tier 4 (Non-Preferred Brand): Higher cost

• Tier 5 (Specialty Drugs): Highest cost

It’s not just about what’s covered—it’s about how much it’ll cost you per refill. Plans can change formularies yearly, so reviewing them during the Medicare Annual Enrollment Period (October 15 to December 7) is crucial.

Step 2: Compare Total Costs, Not Just Premiums

Premiums get the most attention, but they’re only part of the picture. When evaluating Medicare Advantage prescription coverage, you should also consider:

• Copayments and Coinsurance: What you’ll pay each time you fill a prescription.

• Deductible: How much you must spend before the plan starts covering drugs.

• Annual Out-of-Pocket Maximum: The total you’ll pay before full coverage kicks in for medical costs.

• Coverage Gap (“Donut Hole”): Understand if your plan offers extra help once you hit the gap.

Sometimes, a plan with a slightly higher premium actually saves you money overall because of lower copays or a broader formulary. Senior Insurance Quote often helps clients run the numbers so they can see the full picture—not just the monthly price tag.

Step 3: Review Pharmacy Network Access

Every plan has a pharmacy network, which determines where you can fill prescriptions affordably. The difference between “preferred” and “standard” pharmacies can be surprisingly large—sometimes up to 30–40% in savings per refill.

Make sure the pharmacy you already use is in your plan’s preferred network. If not, consider switching to a network pharmacy or mail-order option. Many Medicare Advantage Plans also include mail-order benefits that can reduce costs for maintenance medications, which is convenient if you take prescriptions regularly.

If you travel often or spend time between multiple locations, check for national pharmacy chains in the plan’s network for flexibility.

Step 4: Use Trusted Tools and Resources

Choosing the right plan doesn’t have to be guesswork. Several free, official resources can help you compare Medicare Advantage prescription coverage side by side:

• Medicare Plan Finder – Available at Medicare.gov, this is the go-to tool for checking coverage, pricing, and ratings for all available plans in your ZIP code.

• State Health Insurance Assistance Programs (SHIPs) – These state-run programs provide free, unbiased counseling to help Medicare beneficiaries make informed choices. You can find your local SHIP office through Medicare.gov.

Of course, digital tools are only half the story. Local, licensed agents like the team at Senior Insurance Quote can take your medication list, review your coverage options, and recommend the best-fit plan—without overwhelming jargon or fine-print confusion.

Step 5: Watch for Annual Changes

One of the most overlooked steps is re-evaluating your plan each year. Even if your current Medicare Advantage prescription coverage seems perfect, plans can and do change their formularies, pharmacy networks, and pricing annually.

During the Annual Enrollment Period, review your plan’s Annual Notice of Change. Ask:

• Have my premiums, copays, or deductibles changed?

• Are all my medications still covered at the same tier?

• Is my preferred pharmacy still in-network?

A quick yearly review can prevent surprise costs in January and ensure your plan continues to meet your needs.

Step 6: Don’t Forget About Additional Benefits

Many Medicare Advantage Plans go beyond prescription coverage, offering extras like dental, vision, hearing, fitness memberships, or even over-the-counter allowances. While these perks shouldn’t be the only deciding factor, they can add real value—especially if you already use these services.

At Senior Insurance Quote, we help clients weigh these added benefits against the strength of their prescription coverage, ensuring both health and wallet are well-protected.

The Bottom Line

Choosing a Medicare Advantage Plan that truly fits your prescription needs takes time—but it’s worth it. By checking formulas, comparing total costs, confirming pharmacy access, and using trusted tools like Medicare Plan Finder or SHIP, you’ll set yourself up for a stress-free experience and affordable medication coverage.

If you’d like personalized guidance, contact Senior Insurance Quote. With more than 40 years of experience helping Illinois seniors, our independent agents make it easy to compare options, understand your coverage, and choose confidently.