How our numbers work

Where the data comes from

Everything on PlanScout comes from public files — almost all of them published by CMS, the federal agency that runs Medicare. We don't collect plan information from insurers, and no one can pay to change a number.

On our care pages (nursing homes, hospices, equipment suppliers), every measure carries its source, the reporting period the number describes, and the date we retrieved it. Our code refuses to display a measure that is missing any of those three — a number without its date could quietly read as fresher than it is.

• CMS Medicare Advantage / Part D Landscape file. The list of plans in your county, each plan's monthly premium, star rating, and plan type. CMS refreshes it monthly and rolls it to the next plan year each fall. Our current data covers plan year 2026.
• CMS Part D monthly files (plan information, beneficiary cost, formulary). Which drugs each plan covers, the copay or coinsurance for each drug tier, and drug deductibles. CMS publishes these monthly; we reload on the same cycle.
• CMS Plan Benefit Package (PBP) Section D. Each plan's annual medical deductible. Published once per plan year.
• CMS Part C & D Star Ratings. The star ratings shown next to plans. These are CMS's ratings, never ours. Published annually each fall.
• CMS Part D pharmacy network files. Whether a pharmacy is in a plan's network, and whether it is a preferred or standard pharmacy there. CMS publishes this quarterly, and it can lag what plans report to Medicare Plan Finder — which is why we sometimes answer "we couldn't confirm" instead of yes or no.
• NPPES national pharmacy directory. The pharmacy names and locations you can search. Reloaded as needed from the national provider registry.
• CMS Medicare Part D Spending by Drug. Average cost per claim for each drug, used only to estimate coinsurance amounts. The current release covers 2024. Published annually.
• Cost Plus Drugs public price API. Cash prices shown for comparison on drug pages, computed with the pharmacy's published pricing model (cost plus 15% plus a flat labor fee). We re-check that model against live quotes on every load and refuse to publish if it no longer fits. Reloaded as needed.
• CMS nursing home Provider Information and Penalties files. The nursing home directory: inspection results, staffing measures, and penalty records. Reloaded as CMS updates the files.
• CMS Hospice General Information and family survey (CAHPS) files. The hospice directory and family survey results. Reloaded as CMS updates the files.
• CMS Hospice Quality Reporting Program claims measures. Hospice care measures computed from Medicare claims, such as visits in the last days of life. Reloaded as CMS updates the files.
• CMS Medicare supplier billing data (DME). How much of a given kind of equipment each supplier actually billed to Medicare — the basis for supplier ordering on equipment pages. Published annually.
• CMS DMEPOS Fee Schedule. Medicare-allowed amounts for equipment codes. Published quarterly.
• CMS Opioid Treatment Program provider file. The opioid treatment provider directory. Reloaded as CMS updates the file.

What the cost estimate includes — and leaves out

When you enter your medications, each plan's "estimated total monthly cost" adds up four things:

• The plan's monthly premium, as CMS published it.
• Your drugs' flat copays on that plan, using the cost tier of the pharmacy you chose. If we couldn't confirm your pharmacy on a plan, we price at the preferred-pharmacy tier and label the number as an assumption — your actual cost could be higher.
• The plan's drug deductible, spread over 12 months — but only when at least one of your drugs sits on a tier the deductible actually applies to. A deductible that would never touch your drugs is not counted against the plan.
• An estimate for drugs charged as coinsurance (a percentage instead of a flat copay), when the drug matches CMS's national average cost per claim (2024 data). One claim is treated as one 30-day fill.

Complete, estimated, or incomplete — every total says which

A plan's cost is "complete" only when its premium is published and every one of your drugs has a flat, known copay. If any drug is charged as coinsurance, the total is at most an estimate — and it is labeled as one. If a coinsurance drug has no CMS average to estimate from, or the plan's premium isn't published, the total is incomplete: we still show the parts we know, but that plan is never placed first, no matter how low its known costs look.

Plans whose costs are within 50 cents a month of each other are treated as tied — the source data isn't precise enough to call that a real difference. Ties are broken by the lower in-network out-of-pocket maximum, then by whether the plan has a Part B giveback. The giveback is only ever a tiebreaker: CMS data carries no dollar amount for it, so we never subtract it from a plan's cost.

Every ranked plan carries a "why" panel naming the factor that decided its position. If a sorting priority you picked isn't available in the data for a plan, the panel says so instead of quietly sorting on something else.

When we don't know, we say so

The most important rule in our code: an absence in the data is never turned into an answer. Real examples, exactly as they ship:

• If CMS did not publish a plan's premium, we show "Not published" and rank that plan below plans with known costs. We never show it as $0.
• If a plan's medical deductible varies by service category, no single plan-level number exists — so we show none, rather than inventing one. A published $0 deductible, by contrast, is shown as a real $0.
• If different segments of the same plan report different deductibles, we say it varies rather than silently picking one.
• A pharmacy has four possible answers on a plan: preferred, standard (in network, ordinary cost sharing), out of network, or "we couldn't confirm." Unknown is never rendered as out of network — a wrong "not covered" could push someone off a plan that suits them.
• Doctors are always marked "not checked." No public data source lets us confirm whether a doctor takes a specific Medicare Advantage plan, so we never pretend to.
• When CMS suppresses a care measure (for example, too few patients to report reliably), we show CMS's own reason for the gap instead of a blank or a zero.

What we never do

These are hard rules, enforced by automated tests that fail our build if the code or copy breaks them:

• We never crown a plan or use endorsement language. An automated check scans our wording against a banned-word list and rejects any of it — including on this page.
• We never render an unknown as a no, or a missing number as $0.
• Missing data earns no ranking credit: a plan with an unknown value for the thing you're sorting on sorts below plans with known values, and a plan with incomplete costs is never placed first.
• No provider or plan pays for its position. Care directories are ordered by public data, and each list states the basis it is ordered by.
• We don't compute our own quality scores. Star ratings and care measures are CMS's numbers, shown with their source and period.

Independence — and one ask

PlanScout is a free, independent tool. We are not an insurance company, agency, or agent, and we are not affiliated with or connected to Medicare, CMS, or any insurer. We don't earn anything based on which plan you pick.

One ask: treat everything here as a starting point, not a final answer. Plan information is derived from public files and may be incomplete or out of date. Confirm all details with the plan or a licensed agent before enrolling.

Known limits

• No doctor-network data exists in public files, so doctor coverage is never checked here — ask the plan directly.
• Drug cost estimates are estimates. Coinsurance figures use 2024 national averages, and your pharmacy tier may differ from the one we priced.
• CMS files lag reality. The pharmacy network file is quarterly and can trail what plans report to Medicare Plan Finder; landscape data refreshes monthly.
• Plan data currently covers plan year 2026. When CMS publishes the next year's files, our loaders pick them up.
• We show the plans present in the CMS data we use, which may not be every plan available in your area.