5 Questions to Ask Before Picking a Medicare Advantage Plan in Buffalo, NY

When it comes to Medicare Advantage, the lowest premium isn't always the best deal. A plan that looks affordable on paper can end up costing you far more if your doctors aren't in-network or your medications aren't covered.

Before you make a decision during this year's Annual Enrollment Period (October 15 – December 7), here are five questions every Buffalo-area senior should ask.

1. Are My Doctors In-Network?

This is the single most important question — and the one most people forget to ask.

Medicare Advantage plans use networks of doctors, hospitals, and specialists. If your preferred providers aren't in-network, you'll either pay significantly more to see them or need to find new doctors.

Before enrolling in any plan, verify that your primary care physician, any specialists you see regularly, and your preferred hospital (like ECMC, Buffalo General, or Roswell Park) are all in-network.

2. Are My Medications Covered?

Every Medicare Advantage plan that includes drug coverage (Part D) has a formulary — a list of covered medications. Your prescriptions may be covered at different tiers, with different copays.

Make a list of every medication you take and check each one against the plan's formulary. Pay attention to the tier level, not just whether it's covered. A drug on Tier 3 can cost significantly more than the same drug on Tier 1.

3. What Are the Out-of-Pocket Costs?

The monthly premium is just one piece of the cost picture. You also need to consider:

• **Copays and coinsurance** for doctor visits, specialist visits, and hospital stays
• **Deductibles** for medical and drug coverage
• **The annual out-of-pocket maximum** — the most you'd pay in a year before the plan covers 100%

A plan with a $0 premium but a high out-of-pocket maximum can be a bad deal if you use your coverage frequently.

4. What Extra Benefits Does the Plan Include?

Many Medicare Advantage plans offer benefits that Original Medicare doesn't cover, such as:

• Dental (cleanings, X-rays, sometimes major work)
• Vision (eye exams, glasses or contacts)
• Hearing (exams and hearing aids)
• Fitness memberships (like SilverSneakers)
• Transportation to medical appointments
• Over-the-counter allowances

These benefits vary widely between plans. If you use dental or vision care regularly, a plan with strong extra benefits could save you hundreds of dollars a year.

5. Is the Plan's Star Rating High?

Medicare rates every Advantage plan on a 1–5 star scale based on quality of care, customer service, and member satisfaction. Plans with 4 or 5 stars generally have better outcomes and fewer complaints.

You can find star ratings at Medicare.gov, or ask your advisor to walk you through the options.

Answering these five questions on your own can take hours of research. Or you can spend 20 minutes on the phone with a local, independent advisor who already knows the Buffalo-area plans inside and out.