How Medicare365 Compares Medicare Plans: Methodology and Disclosures

Reviewed September 24, 2026. A Medicare plan comparison should explain both the factors considered and the limits of the comparison. This page describes the information Medicare365 uses to help a prospective client review coverage and the facts each person should verify before enrolling.

Medicare365’s About Us page identifies example companies the agency works with and explains that insurance companies, rather than clients, pay the agency. Carrier relationships and local plan availability can change, so ask the agent for the current list of companies and plans the agent can represent in your ZIP code.

How we organize a plan comparison

A useful comparison begins with the person’s health-care needs and then checks current plan documents. It should not begin with an advertised extra benefit or a single monthly premium.

1. Confirm location and eligibility

We start with the ZIP code, county, Medicare effective dates, current coverage and the enrollment period that may apply. Medicare Advantage and Part D plans have service areas, and an enrollment request must meet Medicare’s eligibility and timing rules.

2. Record prescriptions and preferred pharmacies

We use the exact drug name, dose, quantity and refill frequency, along with preferred pharmacies. For each plan under review, the person should confirm formulary status, drug tier, restrictions, deductible treatment and estimated yearly cost. Results can change when a medication, pharmacy or plan formulary changes.

3. Check doctors, hospitals and other providers

For Medicare Advantage comparisons, we check the current provider directory and encourage the client to confirm participation directly with each important provider. The review can include a primary doctor, specialists, hospitals, laboratories, imaging centers, therapy providers and durable medical equipment suppliers. Provider networks may change during the plan year.

4. Compare the complete cost picture

We compare the available plan’s premium, medical and drug deductibles, copayments, coinsurance, medication costs and medical maximum out-of-pocket limit. We consider both an expected-use year and a higher-use year when practical. A zero-dollar or low premium does not mean all covered care is free.

5. Review plan rules and access to care

The comparison should identify the plan type, service area, provider-network rules, referral requirements and prior-authorization requirements for anticipated care. It should also consider travel, seasonal residence and the need for routine non-emergency care away from home.

6. Examine supplemental benefits in context

Dental, vision, hearing, transportation, meals, fitness and allowance benefits can differ by plan and year. We review limits, frequency, eligible services or items, participating providers and prior-authorization rules using the plan’s current documents. These benefits should be considered alongside medical access, prescriptions and total cost.

7. Review authoritative plan documents before enrollment

Before a final decision, the person should review the plan’s Summary of Benefits, Evidence of Coverage, formulary, provider directory and applicable enrollment materials. Medicare provides rules for how plans and agents may market coverage. Read Medicare’s marketing rules for health plans.

How agent compensation works

Private insurance companies commonly compensate agents and brokers for Medicare Advantage and Part D enrollments. CMS publishes plan-level compensation data and explains that agents generally receive an initial payment for a new enrollment and renewal compensation in later years when the member remains enrolled or makes certain plan changes. Agents must be licensed in the state where they do business, complete annual training and testing, and follow Medicare marketing rules.

See CMS’s current agent and broker compensation information. Compensation is one reason consumers should understand which companies an agent represents and independently verify the full set of plans available in their area.

What our comparison does not guarantee

• It does not guarantee that a doctor, hospital, pharmacy, medication or benefit will remain available.
• It does not guarantee that a plan will produce the lowest possible cost under every health-care scenario.
• It is not a complete listing of every plan available in every service area.
• It does not replace the plan’s contract, Evidence of Coverage, formulary or provider directory.
• It does not replace advice from Medicare, a State Health Insurance Assistance Program, a state insurance department, a health-care professional, tax professional or attorney when their expertise is needed.

Questions to ask before choosing a plan

• Which insurance companies and plans can this agent represent in my ZIP code?
• Are there plans available through Medicare.gov that this agent cannot offer?
• How is the agent or agency compensated if I enroll?
• Were all my prescriptions, pharmacies, doctors and hospitals included?
• Which costs and plan rules could materially affect me?
• Which information did the plan provide, and what should I verify independently?
• What enrollment period or underwriting rules apply before I leave my current coverage?

Verify the result independently

Enter your complete medication list and preferred pharmacies in Medicare Plan Compare. Compare the results with the plans discussed by the agent. You may also contact 1-800-MEDICARE for information about all Medicare Advantage and Part D plans available in your area. If you believe marketing information was inaccurate or misleading, Medicare says to call 1-800-MEDICARE and explain the situation.

Primary sources

• CMS: Managed Care Marketing
• CMS: Agent and Broker Compensation
• Medicare.gov: Marketing Rules for Health Plans
• Medicare.gov: Plan Compare

This page provides general educational information. Plan availability, benefits, costs, networks, formularies, compensation arrangements and enrollment rules can change. Verify current information with Medicare, the insurance company and the applicable plan documents before enrolling or changing coverage.