How to Check Your Doctors and Drugs Before Choosing a Plan

Before you choose a Medicare plan, confirm two things for the coming year: that each of your doctors is in that exact plan's network, and that each of your prescriptions is on that plan's drug list at a cost you can live with. Use Medicare Plan Finder on Medicare.gov or the plan's own 2027 provider directory and formulary, then call your doctors' billing offices and the plan to confirm. Networks and drug lists change every January, so check against 2027 information, not this year's. If you choose Original Medicare with a supplement, there is no network to check, only whether your doctors accept Medicare. Annual Enrollment for 2027 coverage runs October 15 to December 7, 2026.

Step 1: make your lists

• Every doctor you see: primary care, specialists, and any you expect to need. Write the full name and the office address, because networks are often by location.
• Hospitals and facilities you would want to use, including for surgery, rehab or a skilled nursing stay.
• Every prescription: name, strength, form (tablet, injection, inhaler), and how many you take a month.
• Your pharmacy, a second pharmacy you could use, and whether you would use mail order.
• Your Medicare card and, if you have one, your current plan's Annual Notice of Change, which plans mail by the end of September.

Step 2: run your drugs through Medicare Plan Finder

Medicare Plan Finder is the official comparison tool at medicare.gov/plan-compare. The screens change a little from year to year, but the flow is the same.

• Choose whether to log in. Logging in to your Medicare account lets the tool save your drug list and see the coverage you already have; you can also continue without logging in.
• Pick the kind of coverage to compare: Medicare Advantage plans (Part C, most with drug coverage), stand-alone drug plans (Part D) to pair with Original Medicare, or Medigap policies.
• Enter your ZIP code and choose your county. Brighton's 80601 is in Adams County, where the CMS 2027 Landscape lists 36 Medicare Advantage plans from 10 companies, not counting Special Needs Plans.
• Answer the question about help with costs, such as Extra Help or Health First Colorado (Medicaid). It changes the drug costs the tool shows.
• Add each drug by name, then choose the exact strength, form, quantity and how often you fill it. A wrong strength gives a wrong price.
• Choose your pharmacies. Prices can differ between a preferred pharmacy, a standard network pharmacy and mail order.
• Sort the results by estimated total drug and premium cost, not by premium alone, and open the plan details for the plans near the top.
• In plan details, read the drug coverage section for each medicine: whether it is covered, its tier, what you pay before and after the deductible, and any restriction such as prior authorization, step therapy or a quantity limit.
• Compare a short list of plans side by side, and write each plan's estimated yearly cost and its exact name and plan ID on your worksheet.

How to read a formulary tier

Each plan has its own formulary, the list of drugs it covers (Medicare.gov), and most plans sort those drugs into tiers. A lower tier usually costs you less. Plans set their own tiers, so the same drug can sit on tier 2 in one plan and tier 4 in another. A common layout looks like the table below, but always read the plan's own document.

For 2027, a plan's Part D deductible can be no more than $700, and many plans apply it only to higher tiers. Once your out-of-pocket spending on covered drugs reaches $2,400 in 2027, you pay $0 for covered drugs for the rest of the year (CMS CY2027 Rate Announcement). Drugs that are not on the plan's formulary do not count toward that cap.

Prior authorization, step therapy and quantity limits

• Prior authorization: you or your prescriber must get the plan's approval, based on its requirements, before it covers the drug (Medicare.gov).
• Step therapy: a form of prior authorization where the plan asks you to try a lower cost drug first; Medicare.gov notes that if one is available, the first drug tried must be a generic or a biosimilar.
• Quantity limits: the plan covers only a set amount over a period, for example 30 tablets a month (Medicare.gov).
• Exceptions: you or your prescriber can ask the plan for an exception to any of these rules, with a statement from the prescriber that it is medically necessary (Medicare.gov). Ask your doctor before you enroll whether they will support one.

Step 3: check the doctors, then confirm by phone

Search the plan's 2027 provider directory, or the doctor information shown in Medicare Plan Finder, for each doctor by name and location. A federal rule that applies from January 1, 2026 requires Medicare Advantage plans to give CMS their provider directory data for Medicare Plan Finder, update it within 30 days of learning of a change, and attest at least once a year that it is accurate (CMS-4208-F2, Federal Register, September 2025). That helps, but directories still lag behind real life.

So call twice. First, call each office's billing staff and ask the right question: "Will Dr. ___ at this location be in network with [exact plan name and plan ID] for 2027?" Asking whether they take a company's plans is not enough, because a doctor can be in one plan from a company and not another. Second, call the plan's member or sales line and ask the same question about the same doctor and address. If the answers disagree, keep looking until they agree.

For HMO plans, check whether you need a referral to see your specialists, and which hospital your primary care doctor admits to.

Check the hospital too, especially on the Front Range

Medicare Advantage networks in the northeast metro are often built around particular hospital systems, and the hospital is where the largest bills happen. Hospitals near Brighton in the CMS hospital file include Intermountain Health Platte Valley Hospital in Brighton, HCA HealthOne Mountain Ridge in Thornton and University of Colorado Hospital in Aurora. Which of them a plan includes differs from plan to plan and can change each year, so put the hospital you would actually use on your list and check it the same way you check a doctor.

Plan type matters here. In Adams County for 2027 there are 14 PPO plans, 12 HMO plans with a point of service option and 10 HMO plans (CMS CY2027 Landscape). A PPO lets you use an out-of-network hospital at a higher cost; an HMO usually covers out-of-network care only for emergencies and urgent care.

A worked example from Brighton

This is an illustration of the process, not advice about any plan. Say you live in Brighton (ZIP 80601), see a primary care doctor in Brighton and a cardiologist in Thornton, would want Intermountain Health Platte Valley Hospital for a stay, and take three prescriptions: two generics and one brand name drug.

In Plan Finder you choose Medicare Advantage plans, enter 80601 and Adams County, add the three drugs at their exact strengths and your pharmacy, and sort by estimated total cost. Say the first plan on the list puts the brand drug on tier 3 with prior authorization, and the second has it on tier 3 with no restriction for a slightly higher estimated cost. You write down both. Then you search each plan's directory for the two doctors and the hospital, and call the two offices and both plans. If the cardiologist is in network on the second plan but not the first, the second plan is the one that fits, even though it looked a little more expensive on screen, because seeing the cardiologist out of network on an HMO could mean paying the whole bill.

Finally, you check the hospital copay in each plan's Summary of Benefits. A 2027 Adams County HMO-POS plan (an HMO with a point of service option), for example, lists $395 a day for days 1 to 6 of an in-network stay (CMS 2027 Plan Benefit Package, plan H0609-012). Those numbers go on the worksheet next to the drug costs, so you compare the whole year, not only the pharmacy.

If you choose a Medicare Supplement

A Medicare Supplement has no network. Any doctor or hospital in the country that accepts Medicare works. The question to ask is whether the office accepts Medicare assignment, meaning it agrees to the Medicare-approved amount. Plan G also pays Part B excess charges if a doctor does not accept assignment. You still need to check your drugs against a stand-alone Part D plan, using the same Plan Finder steps with "drug plans" selected.

Questions about convenience and quality

• Where are the doctors' offices, and what are their hours?
• Can you get prescriptions by mail, and is there a cost difference?
• Do your doctors use electronic health records and e-prescribing?
• How have members rated the plan? CMS published the 2027 Star Ratings on October 8, 2026, and they appear on Medicare Plan Finder for this enrollment period (CMS). Our own plan tables still show 2026 ratings until our data snapshot is refreshed, so check the 2027 rating on Plan Finder.
• Will the plan cover you when you travel to another state or outside the U.S.?

What to ask the office and the pharmacy

• To the doctor's billing office: "Will Dr. ___ at this address be in network with [exact plan name and plan ID] for 2027? Is the doctor accepting new patients on that plan?"
• To the doctor: "If my plan requires prior authorization or step therapy for this drug, will you support an exception if I need one?"
• To the pharmacy: "Are you a preferred pharmacy for [plan name] in 2027? What would my 30 day and 90 day costs be for these drugs?"
• To the plan: "Is this doctor at this address in network for 2027? Is this drug on your 2027 formulary, on which tier, and with any restrictions?"

Free help comparing plans

Medicare Plan Finder on Medicare.gov is free and lists the plans offered in your ZIP code, and 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) answers questions 24 hours a day. I also run this comparison with you at no cost and with no obligation: (303) 887-8584. If your income is limited, ask about Extra Help and the Health First Colorado Medicare Savings Programs, because they change your drug costs and the plans worth comparing.

Keep a record

Write down who you spoke with at each doctor's office and at the plan, the date and the answer. If a directory listing turns out to be wrong after you enroll, that record helps if you need to ask Medicare for a Special Enrollment Period or the plan for help with costs.

What Lisa checks for you

Lisa takes a commonsense approach: she asks questions, listens to your answers, and only then recommends the type of plan that fits. When you bring your lists, she enters your drugs and pharmacy, narrows the plans to those whose networks include your doctors and your hospital, and reads each finalist's 2027 Summary of Benefits for hospital, specialist and imaging copays. She flags prior authorization, step therapy and quantity limits on your drugs, confirms the doctors by phone where a directory is unclear, and shows you the total yearly cost side by side. You decide, and she helps with the application.

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The bottom line

Check doctors, hospital and drugs against the exact 2027 plan, confirm with a phone call to the office and the plan, and compare total yearly cost, not premium alone. That hour of homework prevents most Medicare surprises. If you would rather not do it alone, bring your lists to our Brighton office or send them through our contact page and we will run the checks with you.