Ratings Methodology for Medicare Advantage

Our writers and editors evaluate thousands of Medicare Advantage plans to find the best based on cost, quality and customer satisfaction.

23Companies reviewed

5,089Medicare plans compared

3.05MData points analyzed

5.0

Overall score

Cost (40%)

The best Medicare Advantage plans have affordable premiums and out-of-pocket costs. We give the highest weight in this category to each plan’s monthly premium. To compare out-of-pocket costs for prescription drugs, we analyze plans’ $0-deductible formulary tiers and estimated costs for prescription drugs at formulary Tier 1 through Tier 3. (Plans without prescription drug coverage aren’t scored on these metrics, and the other cost metrics are re-weighted accordingly.) To compare out-of-pocket costs for medical care, we analyze plans’ copays and/or coinsurance for typical emergency department visits, ambulance rides and seven-day hospitalizations. We also compare each plan's maximum out-of-pocket spending cap (MOOP).

Customer satisfaction (30%)

The best Medicare Advantage plans make it easy to use the plan’s coverage to get care and services. We give the highest weight in this category to Centers for Medicare & Medicaid Services (CMS) measures in Domain 3 - Member Experience with Health Plan. These measures include ratings for members’ ability to get needed care, timeliness of care, customer service, care coordination and members’ ratings of their plans and the care provided. We also compare plans’ complaint rates and problems reported by members who choose to leave plans.

Quality (30%)

The best Medicare Advantage plans deliver quality care and help members manage their health conditions. Our quality scores are based primarily on CMS’ overall ratings for Medicare Advantage plans, which include 32 measures for health plans’ performance and 13 additional measures for plans that include prescription drug coverage.

Data collection and review process

We reviewed 23 Medicare Advantage brands covering about 87% of all Medicare Advantage beneficiaries in the United States. In some cases, one parent company has multiple brands under its umbrella. (For example, we review both UnitedHealthcare and Peoples Health, a UnitedHealthcare subsidiary.)

We research and analyze all commercial Medicare Advantage plans and publish reviews for selected companies. At the national level, NerdWallet’s reviews include each of the 10 largest brands by enrollment. At the state level, we review at least one major insurer in every state where Medicare Advantage plans are sold, and both of the top two insurers in 40 of those 49 states. (Alaska doesn't offer Medicare Advantage plans.)

We also look at online search volume to identify regional and other notable players in the space.

We collect data points for each Medicare Advantage company from its public-facing websites, plan materials, company representatives, public filings and regulator data. These data points are then compared against one another and against NerdWallet’s standards for good health insurance to determine a score for each individual Medicare Advantage plan. Reviewed companies’ star ratings are the average of the ratings we assign to the Medicare Advantage plans they offer, weighted by enrollment.

Data is collected on a regular basis and reviewed by our editorial team for consistency and accuracy. Final star ratings are presented on a scale of 1 to 5 stars, where a 1-star score represents "poor" and a 5-star score represents "excellent." Ratings are curved and rounded to the nearest tenth of a star.

What our star ratings mean

5.0

EXCEPTIONAL

Companies with 5 stars are exceptional, with low premiums, competitive out-of-pocket costs, good quality ratings and happy members.

4.5

EXCELLENT

Companies in the 4.5 star range are excellent, but might trail leaders' performance on one or two factors.

GOOD

Companies with around 4 stars are strong performers that might not be as well rounded as higher-rated competitors.

3.5 stars or fewer

LESS COMPETITIVE

Companies with 3.5 stars or fewer could do better in certain criteria, like pricing and customer complaints.

Information updates

Our writers and editors review insurance companies on at least an annual basis and make additional updates throughout the year as necessary. We maintain contact with companies and monitor public data and regulatory filings to keep information current.

Factor evaluation

Cost metrics (40%)

Premiums. We collect premium data for all commercially available Medicare Advantage plans from CMS’ Landscape files, which are updated at least annually. Plans receive higher scores for lower monthly premiums, with the highest score going to plans with $0 premiums.

Average maximum out-of-pocket spending cap (MOOP). We also compare plans’ caps on out-of-pocket costs based on Landscape file data. Plans with lower maximum out-of-pocket costs get higher scores.

$0-deductible formulary tiers. We collect data about prescription drug coverage from CMS’ Prescription Drug Plan Formulary and Pharmacy Network Information files. Using beneficiary cost data, we score plans based on whether the prescription drug deductible applies on Tier 1, Tier 2 and Tier 3 of their formulary. Plans get higher scores for offering more $0-deductible tiers.

Average out-of-pocket costs for prescription drugs. We compare estimated out-of-pocket costs for prescription drugs on formulary tiers 1 through 3. To compare both copays and coinsurance, we use reference prices of $15 for Tier 1, $50 for Tier 2, and $200 for Tier 3. Plans with lower out-of-pocket costs get higher scores, with the highest scores going to plans with $0 out-of-pocket costs.

Average out-of-pocket costs for medical care. We collect data about medical coverage from CMS’ Benefits Data files. We compare estimated out-of-pocket costs for three common and potentially unexpected medical services: emergency visits, ambulance rides and hospitalizations. To compare both copays and coinsurance, we use reference charges:

For ambulance rides, we use $1,200 based on MedPAC’s June 2026 report to Congress.
For emergency visits that don’t result in a hospitalization, we use a value of $800 to represent the allowed amounts for a high-severity visit that doesn’t result in an admission to the hospital for inpatient care. That’s based on the rounded sum of Medicare’s physician payment rate for CPT 99285 and facility fee for APC 5025.
For hospitalizations, we compare hospital copays for a seven-day hospital stay, based on the average length of stay for Medicare Advantage beneficiaries, according to a study by the American Medical Association.

Plans with lower out-of-pocket costs receive higher scores for each service.

Customer satisfaction metrics (30%)

CMS member experience ratings. We compare plans’ performance on the “Member Experience” domain for CMS star ratings. That domain’s measures include: Getting Needed Care, Getting Appointments and Care Quickly, Customer Service, Rating of Health Care Quality, Rating of Health Plan and Care Coordination. We score plans according to their contract’s average performance on these measures.

Complaint rate. We compare complaint rates, measured as the number of complaints per 1,000 members from CMS’ Star Ratings measure data, which is published at the contract level. Plans whose contracts have lower complaint rates get higher scores.

Disenrollment survey data. CMS surveys members who voluntarily disenroll from Medicare Advantage plans about problems that led them to leave. We evaluate survey data included with CMS’ Star Ratings data tables to calculate an index based on the overall prevalence of problems identified by disenrolling members at the contract level. Plans whose contracts have a lower disenrollment index get higher scores.

Quality metrics (30%)

Overall CMS rating. We use CMS’ top-level star ratings as our measure of plans’ quality. For plans that include prescription drug coverage, we use the overall star rating, which includes both health plan and prescription drug measures. For plans without prescription drug coverage, we use the Part C summary rating. Plans whose contracts have higher star ratings get higher scores.

The review team

The writers and editors behind our Medicare Advantage reviews are insurance specialists who have had their work featured by or appear in The Associated Press, The Washington Post, USA Today, ABC News, Yahoo Finance, Nasdaq and MarketWatch. Each writer and editor follows NerdWallet’s strict guidelines for editorial integrity.

In addition to Medicare Advantage, the team also covers Medicare Supplement Insurance, Medicare Part D, other insurance products and additional subjects related to healthcare and personal finance.