Methodology: How We Compare Medicare Plans

InsuranceDataNow helps you compare Medicare options using publicly available government data. We organize and present CMS plan data—we don't modify it or create proprietary scores.

Why We Built This

The Medicare comparison industry has a problem. Most "comparison" sites are actually lead generators. They collect your information, sell it to agents, and you get flooded with calls. The agents pushing plans often earn commissions that vary by plan—creating an incentive to recommend what pays best, not what fits best.

We think that's broken.

InsuranceDataNow doesn't sell insurance. We don't employ agents. We don't collect your phone number. We simply show you the same CMS data that agents use—organized, searchable, and free from sales pressure.

The data should speak for itself. When you see 47 plans ranked by Star Rating, you can trust that ranking wasn't influenced by who pays us more. We use CMS's official Star Ratings and publicly available data—the same information available to everyone, just presented in a way that actually helps you make a decision.

What This Site Is (and Isn't)

InsuranceDataNow helps you compare Medicare Advantage (Part C) and Prescription Drug (Part D) plans using publicly available datasets and local context.

We do not provide medical advice. Plan benefits, costs, and networks can change—always confirm details with the insurer and at Medicare.gov before enrolling.

Data Sources

All data comes from official government sources and trusted third-party providers. We organize public data—we don't generate our own ratings or accept data from insurers.

• CMS Medicare Plan Data (Monthly)
  Plan availability, premiums, deductibles, formularies, Star Ratings, and benefit details from the Centers for Medicare & Medicaid Services. Includes official quality ratings (1–5 stars) assigned by CMS based on member experience, preventive care, and plan administration. Powers our place pages, condition pages, and D-SNP pages.
• CMS Medicare Part C & D Star Ratings (Annual)
  Plan-level quality scores including condition-specific measures (diabetes care, cardiovascular care, medication adherence, breast-cancer screening, and 40+ others) from cms.gov. Used to rank plans on condition pages.
• CMS Medicare Advantage Plan Benefits (Annual)
  Plan availability, plan type, D-SNP classification (Coordination-Only / HIDE / FIDE), and supplemental benefits from data.cms.gov. Used to build D-SNP pages and identify dual-eligible Special Needs Plans.
• CMS NPPES — National Plan and Provider Enumeration System
  Master registry of every Medicare-enrolled provider — names, credentials, primary specialty, taxonomy codes, practice addresses, phone numbers — from npiregistry.cms.hhs.gov. The foundation of every doctor profile and doctor-landing page on this site.
• CMS Medicare Provider Utilization & Payment Data
  Patient volumes, procedure counts (HCPCS-coded), and average submitted charges by provider from data.cms.gov. Used on doctor profiles to show "what this doctor does" — Medicare-billed procedures and unique patient counts.
• CMS Physician Compare
  Doctor-to-hospital affiliations, group-practice memberships, and accepted Medicare assignment status from data.cms.gov. Used on doctor profiles to surface where a physician practices and admits patients.
• CMS Provider Data Catalog (Hospitals & Pharmacies)
  Hospital quality ratings, infection rates, readmissions, HCAHPS patient-experience scores, and pharmacy facility details from data.cms.gov. Used on hospital pages and place pages.
• CDC PLACES (Annual)
  Census-tract-level chronic-condition prevalence and health-risk-factor estimates from cdc.gov/places. Source data is the CDC's Behavioral Risk Factor Surveillance System (BRFSS) — a state-administered annual telephone survey of U.S. adults 18+. CDC PLACES rolls those state-level estimates down to census tract using small-area estimation. We then aggregate tracts to ZIP using population-weighted block counts. Important methodology note: CDC PLACES estimates are crude (not age-adjusted) and reflect adults 18+, not Medicare-aged adults specifically. We surface them as a contextual signal of community-level disease burden, not as a clinical metric for any individual.
• State Medicaid Programs
  State-by-state Medicaid eligibility rules, income and asset limits, application URLs, and program names — sourced from each state's official Medicaid agency. Used on D-SNP pages to describe how to qualify for the Medicaid side of dual-eligibility. Medicaid rules change frequently; we track the source-of-truth date for each state and refresh as agencies update their published guidance.
• U.S. Census Bureau / American Community Survey (Annual)
  Demographic and community context including population, age distribution, income, and health insurance coverage from census.gov.
• FCC Broadband Map
  Internet availability and broadband coverage data from the Federal Communications Commission. Used to surface telehealth-readiness context.
• Telehealth.HHS.gov
  Official telehealth guidance for patients and providers from the U.S. Department of Health & Human Services.
• ISP Reports
  Address-level internet provider coverage and availability data from ispreports.org. Used to support telehealth-readiness checks on place, condition, D-SNP, and doctor pages.
• BestNeighborhood.org
  Community demographic profiles, commute times, employment context, and economic indicators from bestneighborhood.org. Each cluster page type (place, condition, D-SNP, doctor) surfaces a different cut of this data tailored to the page's purpose — economic stress signals on condition pages, dual-eligible market signals on D-SNP pages, accessibility/commute on doctor pages, demographic context on place pages.
• CrimeGrade.org
  Block-level safety analytics for U.S. zip codes from crimegrade.org. Surfaced as community-context signal on place, condition, D-SNP, and doctor pages.

Data Freshness

Every page displays when its data was last refreshed. Different data sources update on different cadences:

• CMS plan data (Part C, Part D, formularies): Updated monthly when CMS releases new files
• CMS Star Ratings: Updated annually each fall for the upcoming plan year
• CMS NPPES: Provider self-reported registry; refreshed quarterly on our side
• CMS Provider Utilization & Payment Data: Released annually with a ~2-year lag
• CDC PLACES: Updated annually each fall
• State Medicaid program data: Reviewed and refreshed at least once per quarter, or whenever a state publishes a material change
• ACS demographic data: Updated annually with each ACS release
• Editorial review date: When our team last verified the page

Place Mapping: How We Assign Plans to Locations

InsuranceDataNow uses a census-block mapping system to keep plan availability and local context consistent across different geography types.

How It Works

1. Block-level foundation: Each of the 8M+ U.S. Census blocks is mapped to a state, county, city, and ZIP code.
2. County availability → blocks: When CMS indicates a plan is available in a county, we assign that plan to all census blocks within that county.
3. Blocks → places: We roll plan availability up from blocks to build pages for each "place" (state, county, city, ZIP).

Why This Matters

This approach lets us:

• Keep CMS plan availability aligned to the geography CMS publishes (typically county)
• Present plan data consistently across different place types
• Merge plan availability with Census demographic context using the same underlying geography

How We Determine "Best" Plans

We do not create our own overall plan score. Instead, we present CMS data in separate leaderboards aligned to common shopping goals:

• Top CMS Star Ratings — Plans ranked by official CMS quality scores
• Lowest Monthly Premium — Plans ranked by out-of-pocket premium cost
• Lowest MOOP — Plans ranked by maximum out-of-pocket limit (Part C)
• Lowest Drug Deductible — Plans ranked by annual drug deductible (Part D)
• Plan Type Mix — Distribution of HMO, PPO, SNP, and other plan types

This approach lets you prioritize what matters most to you—whether that's quality ratings, cost, or coverage limits.

What We Do (and Don't) Do With CMS Data

• We do: Filter by place, organize into leaderboards, and explain how to interpret key fields
• We do not: Modify plan attributes, edit Star Ratings, or re-rank plans using a proprietary scoring model
• We may: Exclude a plan from a specific leaderboard when a required field is missing in the source data (and we label that)

Local Healthcare Context

To help you think through access to care, we show nearby hospitals, pharmacies, doctors, and facility counts using public CMS provider data.

Doctor Profiles & Doctor Directory Pages

Each doctor profile is built from CMS public data — no scraped directories, no paid listings, and no information collected from visitors.

How We Build a Doctor Profile

1. Identity (CMS NPPES): Name, credentials, primary specialty, taxonomy code, and the doctor's self-reported practice address come from the National Plan and Provider Enumeration System.
2. What the doctor does (CMS Provider Utilization & Payment Data): Medicare patient counts and procedure mix come from the annual CMS Provider Utilization file, keyed on the doctor's NPI. We translate HCPCS codes into plain-English procedure names; the underlying codes are auditable against the public CMS dataset.
3. Hospital affiliations (CMS Physician Compare): Where the doctor admits or practices comes from CMS Physician Compare's affiliation file.
4. Location context (sister sites): Practice accessibility (commute time, drive-to-work share) is sourced from BestNeighborhood.org; area safety from CrimeGrade.org; broadband / telehealth readiness from ISPReports.org.

Canonical Place Assignment for Doctors

Some practice addresses fall in census blocks where we don't yet publish a place page (very small ZIPs or PO-box-only ZIPs). For those doctors, we resolve the canonical place using Manhattan-distance nearest-neighbor matching against our published-zip set. Every doctor has exactly one canonical URL — and every other page that links to that doctor (place teasers, condition specialist cards, D-SNP specialist cards, doctor-landing tables) uses that same canonical URL. This avoids "Alternate page with proper canonical" duplicate-content signals when a doctor is referenced from multiple nearby zips.

What We Don't Show on Doctor Profiles

• We do not show plan-specific network status. CMS doesn't publish doctor-level plan acceptance, and verbal verification with the office is more reliable than third-party network directories anyway.
• We do not show patient ratings, surveys, or reviews — only CMS-published facts.
• We do not display anything that requires a visitor to enter personal information.

Chronic-Condition Pages

Condition pages (e.g., diabetes, heart disease, COPD, depression) help Medicare-eligible adults find plans that score well on CMS's condition-specific quality measures and surface the local context that affects condition care.

How We Rank Plans by Condition

1. Identify condition-specific CMS measures. CMS publishes annual Star Ratings across 40+ measures. We map a curated subset to each chronic condition (e.g., for diabetes: HbA1c control, statin therapy in diabetes, kidney disease monitoring, retinal exam, blood-pressure control, medication adherence for diabetes drugs).
2. Compute a composite score (0–100). For each plan in a place, we compute a weighted average of the condition's measures (each measure equally weighted unless CMS itself weights them differently). The score is unit-normalized 0–100. Higher is better.
3. Cohort minimum. A plan must report at least a configurable minimum (typically 50%) of the condition's measures to receive a composite score. Plans below the minimum are shown in a separate "Not Rated by CMS for this Condition" cohort, not penalized — this typically affects newer plans, smaller plans, and Special Needs Plans.
4. No proprietary adjustments. We do not add our own factors, weight one carrier higher than another, or override CMS data. The composite is a deterministic function of CMS-published numbers.

How We Source Local Disease Prevalence

CDC PLACES publishes census-tract-level prevalence estimates for 30+ chronic conditions and health behaviors. We aggregate those tract-level estimates to ZIP using population-weighted block counts from the U.S. Census, then surface ZIP, county, state, and national prevalence side-by-side for context.

D-SNP (Dual-Eligible Special Needs Plan) Pages

D-SNP pages help dual-eligibles — people enrolled in both Medicare and Medicaid — compare the plans built specifically for their situation. Each D-SNP page covers a specific ZIP's plan availability plus the state Medicaid program rules that govern eligibility.

How We Identify D-SNPs

1. We pull every Medicare Advantage plan available in the ZIP from CMS Plan Benefits files.
2. We filter to plans flagged as Special Needs Plans (SNPs) with a dual-eligible target population.
3. We classify each D-SNP as Coordination-Only, HIDE, or FIDE based on CMS Plan Benefits attributes and CMS-published integration data.
4. We cross-reference each plan's CMS Star Rating, premium, and benefit details from the same Plan Benefits files.

State Medicaid Information

The state Medicaid section on each D-SNP page is sourced directly from the state's official Medicaid agency — application URL, program name, income and asset thresholds, and category-specific eligibility paths. Medicaid rules change frequently; we track the source-of-truth date and refresh as agencies update their guidance. Visitors should always verify current eligibility directly with their state Medicaid agency before making enrollment decisions.

Hospital Pages

Hospital profiles are built entirely from public CMS Provider Data — quality ratings, infection rates (HAI), readmission penalties (HRRP), HCAHPS patient-experience scores, and facility characteristics. We display the same data CMS publishes on Care Compare, organized by ZIP and integrated with local context (nearby doctors, plan availability, community demographics).

"Not Rated" hospitals are kept in our directory rather than hidden — CMS's rating methodology requires minimum case volumes, so the absence of a star rating often reflects size or specialty, not quality. We label "Not Rated" clearly so visitors don't infer a quality signal from the absence of one.

Editorial Review and Quality Control

All Medicare content is produced by our editorial team and undergoes review for:

• Accuracy against primary government sources
• Clarity for seniors and caregivers
• Compliant disclosures (affiliate, TPMO)

Each page displays a "Reviewed & approved on" date indicating when our team last verified the content.

Questions?

If you have questions about our methodology or data sources, please contact us.