How to Check Your Doctors and Drugs Before Choosing a Medicare Plan

Short answer: Make a list of every doctor, specialist, hospital and pharmacy you use and every prescription with its dose. For each plan, confirm your providers are in the network for the coming plan year by checking the directory and calling the office, confirm each drug is on the formulary and note its tier and any prior authorization, step therapy or quantity limits, and compare the estimated yearly total cost, not just the premium.

Step 1: Build Your Lists

Everything else depends on two lists, so make them complete:

Providers: your primary care doctor, every specialist, any therapist, the hospital system you prefer, labs and imaging centers you use, and any surgeon you expect to see. Note the clinic location, because one doctor can practice at more than one site.
Prescriptions: every medication you take regularly, with the exact name, strength, dose and how often you fill it. Include inhalers, injectables, insulin and anything filled by mail.
Pharmacies: the pharmacy you use now, plus any you would be willing to switch to.

In the Treasure Valley, many people are loyal to one hospital system. Write that down too, because it may decide the question for you.

Step 2: Check Doctors and Hospitals

How much this step matters depends on the path you choose.

If you are looking at Medicare Advantage

Advantage plans use networks, the doctors, hospitals and other providers the plan contracts with. In an HMO you generally need to use the network except for emergencies; a PPO usually lets you go out of network at a higher cost. For each plan:

Search the plan’s provider directory for the coming plan year, not the current one.
Call each doctor’s office and ask, “Will you be in network with [exact plan name] next year?” Insurers offer several plans, and an office may take one but not another.
Ask whether you need a referral to see a specialist, and whether the hospital you prefer is in network.

Medicare.gov’s own advice when joining a plan is to ask your doctors and pharmacies if they are in network with it.

If you are looking at Original Medicare with Medigap

Medigap has no network. Any provider in the U.S. that accepts Medicare accepts your Medigap. You only need to confirm each doctor accepts Medicare. That simplicity is one reason people choose this path; we compare both in Medicare Advantage vs. Medigap in Idaho.

Step 3: Check Every Drug

Each Part D plan, standalone or inside an Advantage plan, has a formulary, its list of covered drugs, usually grouped into tiers with different costs. For each drug on your list, note:

Is it covered? Spending on drugs the plan does not cover does not count toward the yearly out-of-pocket cap ($2,100 in 2026, $2,400 in 2027).
What tier is it on, and what is the copay or coinsurance?
Are there restrictions? Prior authorization (approval before coverage), step therapy (try a lower-cost drug first) or quantity limits.
Insulin: covered insulin costs no more than $35 for a one-month supply, but only if your insulin is on the formulary.

The most accurate cost estimate for any plan comes from entering every prescription you take regularly, with the dosage and the pharmacy you use. We run that comparison for you at no cost, so you never have to do the data entry yourself. Our Part D guide explains the coverage stages behind those estimates.

Step 4: Check Your Pharmacy

Plans have pharmacy networks, and many have preferred pharmacies where the same drug costs less. Check whether your pharmacy is in network and whether it is preferred. Look at mail order for maintenance drugs, too; some plans price 90-day mail-order fills differently. If you live outside the Treasure Valley, in Boise County or farther out, make sure a convenient in-network pharmacy exists or mail order works for you.

Step 5: Compare the Yearly Total

Premium is only one line. For each plan, add up:

Monthly premiums × 12, including your Part B premium ($202.90 a month in 2026) and any IRMAA
The drug deductible and estimated drug costs at your pharmacy
Likely medical copays for the care you expect: visits, specialists, labs, imaging
For Advantage plans, the yearly out-of-pocket limit, as your worst case
For Medigap, the policy premium plus your Part D plan

Then ask the “bad year” question: if you needed surgery or a hospital stay, what would each option cost? Our Medicare costs guide has the 2026 Original Medicare numbers, and the Medigap cost comparison helps if you are weighing plan letters.

If you live in another state for part of the year, Medicare.gov also suggests checking whether the plan will cover you there.

Repeat It Every Fall

Plans can change premiums, formularies, tiers, networks and pharmacy status every January 1. Each fall your plan sends an Annual Notice of Change. Read it, re-run Steps 2 to 5, and make any change during Open Enrollment, October 15 to December 7. Our enrollment periods guide lists every window. Our answer page on keeping your doctor with Medicare Advantage is a quick reference for the network question.

Want us to run the check for you?

Send us your doctor and prescription lists. We will check them against the Medicare plans we represent in your Idaho county and walk you through the results.

Request a free comparison Call 208-350-9933

Frequently Asked Questions

How do I check if my doctor is in a Medicare Advantage network?

Use the plan’s own provider directory for the coming plan year, then call your doctor’s office and ask whether they will be in network with that specific plan, not just that insurance company. Medicare.gov recommends asking your doctors and pharmacies directly whether they are in network with the plan.

Do I need to check my doctors if I choose Medigap?

Less so. Medigap works with Original Medicare, so any doctor or hospital in the U.S. that accepts Medicare will accept it. You still want to confirm your doctors accept Medicare patients. Your prescriptions still need checking, because you will add a separate Part D plan with its own formulary.

What should I enter in Medicare’s Plan Finder?

Medicare.gov suggests adding all the prescription drugs you take regularly, with the correct dose and how often you fill them, to get the most accurate monthly and yearly cost estimate for each plan. Choose the pharmacies you actually use, and compare the estimated yearly total, not just the premium.

Can a plan change its network or drug list during the year?

Plans set their benefits, formularies and networks for each calendar year, and changes for the next year are described in the Annual Notice of Change you receive each fall. Provider networks can change during a year, too. That is why it is worth reviewing your plan every Open Enrollment, October 15 to December 7.

What if I split the year between Idaho and another state?

Medicare.gov suggests checking whether a plan will cover you in the other state if you live there part of the year. Many Medicare Advantage networks are local, while Original Medicare with Medigap works with Medicare providers nationwide.

Coverage pages for this topic: Medicare Advantage · Medicare Supplement · Medicare Part D. Other topics in the Learning Center: Health Insurance (ACA), Life Insurance, Final Expense, Annuities, Long-Term Care, Disability Insurance, Supplemental Health, Short-Term Medical, Travel Insurance.

Sources

Figures are labelled with the year they apply to and were checked against the official sources above on the review date. Rules and amounts change; confirm current figures with the agency that publishes them. This guide is general education, not individual advice.