Frequently Asked Questions

Medicare is the federal health insurance program for people aged 65 and older, as well as some younger people with certain disabilities or conditions like End-Stage Renal Disease (ESRD). Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and helps cover hospital stays, doctor visits, prescription drugs, and other medical services. It is divided into several parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).

Medicare Advantage (also called Part C or MA) plans are an alternative to Original Medicare offered by private insurance companies approved by Medicare. These plans bundle Part A (hospital) and Part B (medical) coverage into one plan, and most also include Part D (prescription drug) coverage. Medicare Advantage plans often include extra benefits not covered by Original Medicare, such as dental, vision, hearing, fitness memberships, and over-the-counter allowances. You must still pay your Part B premium, but many MA plans have $0 additional premiums.

Original Medicare (Parts A & B) is run directly by the federal government. You can see any doctor or hospital that accepts Medicare, and there is no network restriction. However, Original Medicare does not cap your out-of-pocket costs and does not cover dental, vision, or hearing. Medicare Advantage plans are offered by private insurers and typically use provider networks (HMO or PPO). In exchange, they offer a maximum out-of-pocket limit, often include extra benefits like dental and vision, and usually include drug coverage. The trade-off is that you may need to use in-network providers for the lowest costs.

Medicare Part D is the prescription drug benefit. It helps cover the cost of your medications. Part D is offered through private insurance companies, either as a standalone Prescription Drug Plan (PDP) that works alongside Original Medicare, or as part of a Medicare Advantage plan (MA-PD). Each Part D plan has its own formulary (list of covered drugs), cost-sharing structure, and network of pharmacies. Part D plans organize drugs into tiers, with lower tiers generally costing less.

Medigap plans (also called Medicare Supplement Insurance) are private insurance policies that help pay for costs that Original Medicare does not fully cover, such as copayments, coinsurance, and deductibles. Medigap plans are standardized and labeled with letters (like Plan G or Plan N). Important: you cannot have both a Medigap plan and a Medicare Advantage plan at the same time. If you choose Medicare Advantage, you do not need Medigap, because MA plans have their own cost-sharing structure and out-of-pocket maximums.

The Annual Enrollment Period (AEP) runs from October 15 through December 7 each year. During AEP, you can make changes to your Medicare coverage for the following year, including switching from Original Medicare to a Medicare Advantage plan, changing your MA plan, switching back to Original Medicare, joining or changing a Part D drug plan, or dropping Part D coverage. Changes made during AEP take effect on January 1 of the next year.

The Medicare Advantage Open Enrollment Period (OEP) runs from January 1 through March 31 each year. During this time, if you are already enrolled in a Medicare Advantage plan, you can switch to a different MA plan, switch back to Original Medicare (and optionally join a standalone Part D plan), or change from an MA plan without drug coverage to one with it. You can only make one change during OEP. This period is specifically for people already in Medicare Advantage — it is not for people on Original Medicare looking to join MA for the first time.

A Special Enrollment Period (SEP) allows you to make changes to your Medicare coverage outside of the standard enrollment windows. You may qualify for a SEP if you move to a new area, lose your current coverage, qualify for Medicaid, live in a nursing home, have a chronic condition (for certain SNP plans), or experience other qualifying life events. Each SEP has specific rules about what changes you can make and how long you have to make them. Contact Medicare at 1-800-633-4227 or your State Health Insurance Assistance Program (SHIP) for guidance.

If you miss the Annual Enrollment Period (October 15 – December 7), you generally have to wait until the next AEP to make changes, unless you qualify for a Special Enrollment Period. If you delayed enrolling in Part B or Part D when you were first eligible (and did not have other creditable coverage), you may face a late enrollment penalty — a permanent increase added to your monthly premium. The Part B penalty is 10% for each 12-month period you were eligible but not enrolled. The Part D penalty is calculated based on the number of months you went without creditable drug coverage.

Most people become eligible for Medicare when they turn 65. Your Initial Enrollment Period (IEP) is a 7-month window that starts 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after. During this time, you can enroll in Part A, Part B, a Medicare Advantage plan, and/or a Part D drug plan. If you are receiving Social Security benefits, you will be automatically enrolled in Parts A and B. If you are under 65, you may qualify for Medicare if you have received Social Security Disability Insurance (SSDI) for 24 months, or if you have ALS or ESRD.

HMO (Health Maintenance Organization) plans require you to use doctors and hospitals within the plan's network for your care to be covered (except in emergencies). You typically need a referral from your primary care provider (PCP) to see a specialist. HMO plans often have lower premiums and out-of-pocket costs compared to PPO plans. The trade-off is less flexibility in choosing providers. If you see an out-of-network provider (non-emergency), you will likely pay the full cost yourself.

PPO (Preferred Provider Organization) plans give you more flexibility than HMOs. You can see any doctor or specialist without a referral, and you can go out-of-network — though you will pay more for out-of-network care. PPO plans typically have higher premiums than HMO plans, but offer the freedom to see providers anywhere in the country that accepts the plan. This makes PPOs a good choice if you travel frequently, split time between two states, or want the flexibility to see specialists without referrals.

Special Needs Plans (SNPs) are a type of Medicare Advantage plan designed for people with specific health conditions or circumstances. There are three types: D-SNP (Dual-Eligible) for people who have both Medicare and Medicaid, C-SNP (Chronic Condition) for people with certain chronic illnesses like diabetes, heart failure, or COPD, and I-SNP (Institutional) for people who live in nursing homes or other institutions. SNPs tailor their benefits, provider networks, and drug formularies to the specific needs of their members. You must meet eligibility requirements to enroll in an SNP.

Part D drug coverage helps pay for prescription medications. Each plan has a formulary — a list of covered drugs organized into tiers. Plans must cover at least two drugs in most therapeutic categories and all drugs in six protected classes (including cancer, HIV/AIDS, and anti-seizure medications). Part D coverage has several phases: the deductible phase (you pay full cost up to the deductible), the initial coverage phase (you pay copays or coinsurance), and the catastrophic phase (after reaching the out-of-pocket cap, the plan pays all remaining costs). Starting in 2025, Part D has a $2,000 annual out-of-pocket cap on drug spending.

Supplemental benefits are extra services offered by many Medicare Advantage plans that go beyond what Original Medicare covers. Common supplemental benefits include dental coverage (cleanings, fillings, dentures), vision coverage (eye exams, glasses, contacts), hearing coverage (hearing exams, hearing aids), fitness and gym memberships (like SilverSneakers), OTC (over-the-counter) allowances for items like vitamins and first aid, transportation to medical appointments, telehealth services, and meal delivery after a hospital stay. The specific benefits and coverage limits vary by plan.

A premium is the fixed monthly amount you pay for your health insurance plan, regardless of whether you use any medical services that month. Think of it like a membership fee. With Medicare, you always pay your Part B premium (which most people pay through Social Security). Many Medicare Advantage plans have an additional $0 premium — meaning you pay nothing beyond your Part B premium. Some plans charge an additional monthly premium for enhanced benefits or drug coverage. A lower premium does not always mean a cheaper plan overall — you should also consider deductibles, copays, and the out-of-pocket maximum.

A deductible is the amount you must pay out of your own pocket for covered services before your insurance plan starts to pay its share. For example, if your plan has a $250 medical deductible, you pay the first $250 of covered medical costs yourself each year. After meeting the deductible, you typically pay copays or coinsurance for services, and the plan pays the rest. Many Medicare Advantage plans have a $0 medical deductible. Drug plans may have a separate drug deductible (up to $590 in 2026). Not all services are subject to the deductible — preventive care is usually covered at no cost.

A copay (copayment) is a fixed dollar amount you pay for a covered service — for example, $20 for a doctor visit or $10 for a generic drug. A coinsurance is a percentage of the cost you pay — for example, 20% of the cost of a surgery. With a copay, you know the exact cost upfront. With coinsurance, your cost depends on the total charge. Many Medicare Advantage plans use copays for common services (like doctor visits and prescriptions) and coinsurance for more expensive services (like surgeries or hospital stays).

MOOP stands for Maximum Out-of-Pocket. It is the most you will pay for covered medical services in a plan year. Once you reach this limit, your plan pays 100% of covered services for the rest of the year. MOOP includes your deductibles, copays, and coinsurance, but does not include your monthly premium or costs for services the plan does not cover. Medicare Advantage plans are required to have a MOOP, which is one of the key advantages over Original Medicare (which has no out-of-pocket cap). In-network and out-of-network services may have different MOOP limits.

A formulary is a plan's list of covered prescription drugs. Each Medicare Part D plan and Medicare Advantage plan with drug coverage maintains its own formulary. Drugs on the formulary are organized into tiers (typically 1-5), with lower tiers having lower costs. Plans can change their formulary from year to year — a drug covered this year may not be covered next year, or may move to a different (more expensive) tier. When comparing plans, always check that your specific medications are on the plan's formulary and note which tier they are on.

Prior authorization (also called pre-authorization or PA) means your plan requires approval before it will cover a specific drug or service. Your doctor must submit a request to the plan explaining why the medication or treatment is medically necessary. If the plan approves, the drug or service will be covered at the normal cost-sharing rate. If denied, you can appeal the decision. Prior authorization is common for expensive medications, certain procedures, and some specialty drugs. It can sometimes cause delays, so it is important to check if your medications require PA when choosing a plan.

Step therapy (also called "fail first") is a policy where your plan requires you to try a less expensive drug before it will cover a more expensive one. For example, if your doctor prescribes a brand-name medication, the plan may require you to first try a generic alternative. If the generic doesn't work for you or causes side effects, the plan will then cover the originally prescribed drug. Step therapy is intended to control costs, but can be frustrating if you have already tried and failed on the required drugs. Your doctor can request an exception if there is a medical reason to skip the step.

Drug tiers are how plans organize medications on their formulary by cost. Most plans use 5 tiers: Tier 1 (Preferred Generic) — lowest cost, typically $0-$10. Tier 2 (Generic) — low cost for other generics. Tier 3 (Preferred Brand) — moderate cost for common brand-name drugs. Tier 4 (Non-Preferred Brand) — higher cost for other brand-name drugs. Tier 5 (Specialty) — highest cost for complex, expensive medications. The same drug may be on different tiers on different plans, which is why comparing formularies is so important when choosing a plan.

The Part B giveback (also called Part B premium reduction) is a feature of some Medicare Advantage plans that reduces your monthly Part B premium. In 2026, the standard Part B premium is $185/month. A plan with a Part B giveback might reduce that by $50-$185/month, effectively putting money back into your Social Security check. Not all plans offer this benefit, and the amount varies by plan. Plans that offer a giveback may have fewer supplemental benefits or higher copays to offset the cost. It is worth comparing the total value of a plan with giveback versus one without.

The donut hole (or coverage gap) was a phase of Part D drug coverage where beneficiaries had to pay a much higher share of drug costs. The good news: starting in 2025, the donut hole has been effectively eliminated thanks to the Inflation Reduction Act. Part D now has a hard $2,000 annual cap on out-of-pocket drug spending. Once you and your plan have spent a certain amount on drugs, you enter the catastrophic phase where you pay $0 for the rest of the year. This is a major improvement that significantly reduces drug costs for people who take expensive medications.

Our tool compares your current plan to its 2026 version across five key areas: total estimated cost, plan quality ratings, supplemental benefits, doctor visit copays, and maximum out-of-pocket limits. Each area gets a score, and we combine them into a single plan score (0-100). If we find significantly better alternatives in your area, we'll suggest you switch or at least take a closer look. If your plan is holding strong, we'll tell you that too. The recommendation is based on how much better your alternatives score compared to your current plan.

The plan score considers five factors: (1) Total estimated cost — including premiums, drug costs, Part B giveback savings, and OTC allowances. (2) Star quality ratings — CMS quality ratings based on member satisfaction, health outcomes, and plan responsiveness. (3) Supplemental benefits — whether the plan includes the benefits you said you wanted (dental, vision, fitness, etc.). (4) Doctor visit copays — how much you pay for PCP visits, specialist visits, and ER visits. (5) Maximum out-of-pocket limit — the most you could pay in a year. Lower costs and better coverage mean a higher score.

The cost estimate includes your monthly plan premiums (multiplied by 12) plus estimated out-of-pocket drug costs. Drug costs are calculated by looking up each of your medications on the plan's formulary, determining the tier and cost-sharing, and simulating the Part D benefit phases (deductible, initial coverage, and catastrophic). We also subtract Part B giveback savings and OTC allowance credits since those are real money back in your pocket. The estimate assumes you fill each prescription monthly at a preferred retail pharmacy. Actual costs may vary.

Even if your current plan looks similar to last year, there may be significantly better options available in your area that you haven't considered. Our tool compares your plan against all available alternatives in your county. A plan might score much higher than yours because it costs less, has better star ratings, includes more of the benefits you want, or has lower copays. Sometimes a small change in your plan combined with a great new option makes switching worthwhile — even when no single change is dramatic.

No. This tool is purely informational. It provides analysis and suggestions to help you make a more informed decision, but it does not enroll you in any plan, submit any applications, or make any changes to your current coverage. Only you can decide which plan is right for your situation. We always recommend reviewing plan details on Medicare.gov or speaking with a licensed Medicare agent before making enrollment changes. The final decision is always yours.

When you add a prescription drug, our tool checks whether an FDA-approved generic equivalent exists — that is, a drug with the same active ingredient (molecule) as your brand-name medication. If a generic is available, we ask whether you'd like us to include it when comparing plans. If you say yes, we check which plans cover the generic version and at what tier, and show you potential savings. We only suggest generic equivalents of the same molecule — we never suggest a different drug in the same class (for example, we would suggest generic empagliflozin for Jardiance, but we would never suggest a different SGLT2 inhibitor). This is a per-drug choice: you decide for each medication whether to consider the generic. Always consult your doctor before switching to a generic, as inactive ingredients may differ.

Our plan data comes directly from the Centers for Medicare & Medicaid Services (CMS) and is updated when CMS releases new plan information for each coverage year. Plan benefits, premiums, formularies, and star ratings are all sourced from official CMS datasets. For the 2026 plan year, data is typically released in the fall before the Annual Enrollment Period (October 15 - December 7). Star ratings may be updated separately by CMS during the year. While we strive for accuracy, we always recommend confirming specific plan details with the plan provider or Medicare.gov.

Yes, Medicare Compare is completely free to use. There are no hidden fees, no credit card required, and no personal information collected. We do not sell your data or require you to sign up for anything. You just need your ZIP code to get started. Our goal is to make it easier for Medicare beneficiaries to understand and compare their plan options.

All plan data on Medicare Compare comes directly from the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers Medicare. This is the same data source used by Medicare.gov. We update our data when CMS releases new plan information for each coverage year. Plan benefits, premiums, formularies, and star ratings are all sourced from official CMS datasets. While we strive for accuracy, we always recommend confirming specific plan details with the plan provider or Medicare.gov before making enrollment decisions.

Start by entering your ZIP code on the home page. You'll see all Medicare plans available in your area. Use the filters on the left to narrow down by plan type, benefits, star rating, and premium. You can optionally add your prescription medications to see estimated drug costs for each plan. Select up to 3 plans by checking the boxes on the plan cards, then click the "Compare" button that appears at the bottom of the screen. The comparison view shows plans side by side with all key details including costs, benefits, and drug coverage.

The "Should I Switch?" tool is designed for people who already have a Medicare plan and want to know if they should change for the next year. You enter your ZIP code, find your current plan, add your prescriptions, and select the supplemental benefits that matter to you. The tool then analyzes what changed with your plan for the new coverage year — including premium changes, star rating changes, drug coverage changes, and cost differences. It gives you a clear recommendation (Stay, Review, or Switch) and shows you the top alternative plans in your area.

The estimated annual cost includes your monthly premiums (multiplied by 12) plus your estimated out-of-pocket drug costs for the year. Drug costs are calculated by looking up each of your medications on the plan's formulary, determining the tier and cost-sharing for each drug, and simulating the Part D benefit phases (deductible, initial coverage, and catastrophic). The estimate assumes you fill each prescription every month at the plan's preferred retail pharmacy. Actual costs may vary based on the pharmacy you use, drug price changes, and any manufacturer discounts. The estimate does not include costs for doctor visits, hospital stays, or other medical services.

Yes — you can search for your doctor by name using our provider search tool, which uses the National Provider Identifier (NPI) registry maintained by CMS. Once you've added your doctors, we provide direct links to each plan's provider directory so you can verify network status. Full automatic network verification is coming in a future update. In the meantime, we recommend checking the plan's provider directory directly before enrolling, or calling the plan to confirm your doctor participates. You can also use the Medicare Plan Finder at medicare.gov/plan-compare to look up provider directories.