How We Review Medicare Companies

Reviewed by Anthony BattleReviewed by Anthony Battle

Investopedia’s lists of the best Medicare companies are based on in-depth research into 13 private companies that provide Medicare coverage. We reviewed costs, plan features, coverage, state availability, and more. This guide explains how we determined what criteria to measure, the methods we used to score each company, and how we chose the best Medicare providers. 

Our editors and researchers independently evaluate all recommended products and services. If you click on links we provide, we may receive compensation. Our advertising partnerships are not a factor in evaluating products, though they may affect the order of products you see listed in our articles.

How We Research Medicare Providers

To form our initial understanding of the Medicare Advantage (MA), Part D, and Medicare Supplement (Medigap) industry, we reviewed research conducted by market intelligence and consulting firms, such as Kaiser Family Foundation (KFF), Chartis Group, and McKinsey. These reports provided insight into individual market share, enrollment growth, and nationwide availability for major Medicare providers in the United States. We considered this information, along with our previous research, to select 13 Medicare Advantage, Part D, and Medigap providers for our review. 

For each of these companies, we collected data from third-party rating agencies such as the credit rating agency AM Best and the National Committee for Quality Assurance (NCQA), an independent organization that rates health care plans on quality and customer satisfaction. We also gathered data from government websites and databases provided by the Centers for Medicare and Medicaid Services (CMS) and directly from companies via websites, media representatives, and existing partnerships. The data collection process ran from Aug. 27 to Oct. 10, 2024.

We then developed a quantitative model that scores each Medicare company based on the data we collected. We ensured the integrity of our data by cross-referencing the records in our database with primary sources.

Data Collection and Scoring 

• Data points are scored on a 0.00 – 1.00 scale
• Binary criteria = [0,1]
• Scaled criteria (e.g., 5-point) = [0.00, 0.25, 0.50, 0.75, 1.00]
• For continuous criteria, the minimum data value collected was re-scaled to 0.00 and the maximum value was re-scaled to 1.00

Medicare Evaluation Categories

We determined key categories with which to evaluate Medicare plans and providers. We weighted them differently depending on the article:

These categories were broken down into 78 criteria, resulting in 1,014 data points. We collected the following criteria for each category.

Customer Satisfaction

Evaluating customer satisfaction ratings can help you choose a company that not only fits your budget and coverage needs but also delivers reliable service. 

We used two ratings to score customer satisfaction. The first is the Consumer Assessment of Healthcare Providers and Systems (CAHPS), a consumer survey CMS conducts that feeds into a star rating system. The second comes from NCQA quality and service ratings.

We scored customer satisfaction on a continuous scale for CAHPS Medicare star and NCQA ratings. 

We also checked whether companies offered live customer service chat on their websites.

NCQA Ratings and Accreditation Status

NCQA star ratings measure the performance of managed care plans and member satisfaction on a scale of 1 to 5 stars. Consumers should look for high NCQA ratings because they help show which plans prioritize care quality and patient well-being. 

For each health plan, we calculated the average NCQA star rating across all rated plans. Star ratings were scored on a continuous scale: The lowest-rated plan received a score of 0, and the highest-rated plan received a score of 1. Molina received the lowest score (2.433), and Kaiser the highest (4.563).

The NCQA also has a rigorous accreditation process. It evaluates plans based on the following areas:

• Quality management and improvement
• Population health management
• Network management
• Utilization management
• Credentialing and recredentialing
• Member experience

For our research purposes, we recorded each company’s percentage of plans with NCQA accreditation and scored this on a continuous scale from 0 to 1.

Live Chat Availability

Live chat is important for consumers who want quick, convenient access to customer support. The availability of this feature was scored on a binary scale–if companies offered the opportunity to message a human representative, they were given a score of 1. If companies did not have a live chat feature or only had an automated chatbot, they were given a score of 0 for this criterion. 

J.D. Power 

We considered J.D. Power’s customer satisfaction scores and rankings for Medicare Advantage companies. The consumer insights firm surveyed 10,718 members of Medicare Advantage plans in 10 states for its 2024 study. We did not score the results because the survey did not cover all the companies in our review, but we took the results into account for editorial purposes. 

NAIC Index

A high frequency of complaints can indicate that an insurance company has problems responding to customer needs. The National Association of Insurance Commissioners (NAIC) is a regulatory organization that maintains a database of complaints filed against insurance companies. With this data, the NAIC creates an index that conveys how many complaints an insurance company has received relative to how many complaints it’s expected to receive based on its market share. We averaged each company’s NAIC index over three years.

If a company receives fewer complaints than expected, its index is less than 1. An index of 0 means the company received no complaints. An index greater than 1 means the company received more complaints than expected. Some examples of types of complaints are delays in benefit payment, poor claim handling, and claim denials.

Using the NAIC Complaint Index, we calculated a three-year weighted average NAIC score for each company’s total premiums and index values from 2021-2023. Our three-year average was scored on a continuous scale from 0 to 1.

Medicare CAHPS Star Ratings

CMS rates the quality of Medicare plans based on data gathered through the CAHPS family of surveys. These ratings can help consumers identify plans that prioritize patient satisfaction and reliable service. 

Ratings are issued on a scale of 1 to 5 stars for the following aspects of a plan:

• Screenings, tests, and vaccines
• Managing chronic (long-term) conditions
• Member complaints and changes in the health plan’s performance
• Member experience
• Health plan customer service

The same process is also used to measure the quality and effectiveness of Medicare Part D drug plans along the following categories:

• Drug plan customer service
• Member complaints and changes in the drug plan’s performance
• Improvement (if any) in the drug plan’s performance
• Member experience and the drug plan
• Drug safety and accuracy of drug pricing

We took all of these ratings into account, as well as overall ratings for:

• Medicare Advantage plans with drug coverage
• Stand-alone Part D plans

CMS uses the ratings for these individual categories to determine an overall Medicare or Part D star rating, providing a quick snapshot of plan performance to help people compare their options during open enrollment.

For each company—for Medicare Advantage and Part D plans—we looked at star ratings across all plans offered nationwide. We then took the averages of the overall CAHPS star ratings and the averages for sub-category ratings. We then scored these averages on a continuous scale: The plan with the lowest nationwide average received a score of 0, and the highest received a score of 1.

Plan Types

We gathered information on the types of plans (HMO, PPO, POS, PFFS, etc.) offered by companies, plan benefits (looking at seven specific benefits), and types of special needs plans offered. Understanding these offerings, such as whether a company covers care through health maintenance organizations (HMO), preferred provider organizations (PPO), or other types of plans, can help you pick a company matching your health care needs and budget.

For the best Medicare Supplement (Medigap) plans, we measured the number of Medigap plan types offered (i.e., A, B, C, D, F, G, K, L, M, N, and high-deductible F and G). More plans allow consumers to find a balance between coverage and costs that best suits their needs.

For the best Medicare Plan G providers, we measured whether Medigap high-deductible plan G was offered. This plan provides coverage at a lower premium cost, which could be important for healthier consumers who want to save money.

Types of Plans (HMO, PPO, Other)

We first scored the availability of HMO and PPO plan types on a binary scale (0 for no, 1 for yes). For “Other Plan Types,” we collected data in a list format. First, we counted the number of additional plan types offered by each company and scored those on a continuous scale from 0 to 1. The company with the most additional plan types received a score of 1, and the least a score of 0. Once we got scores for each individual plan type, we came up with subweights for HMO, PPO, and other types. We multiplied each individual score by the subweight, took the sum, and got a weighted average on a scale of 0 to 1 to get a total plan availability score for each company.

Special Needs Plans (SNPs)

Special Needs Plans (SNPs) provide additional services for individuals with specific chronic or disabling conditions. There are three types of SNP’s:

• Dual-Eligible Special Needs Plans (D-SNP’s): Help coordinate benefits between Medicare and Medicaid for those eligible for both
• Chronic Special Needs Plans (C-SNP’s): For people with chronic conditions, requires authorization from care provider
• Institutional Special Needs Plans (I-SNP’s): For those living in a long-term care facility or in need of a higher level of care

We checked for the availability of each type of Special Needs Plan across all 12 companies, scoring each on a binary scale from 0 to 1 (0 for not offered, 1 for offered). We took the sum of the scores across each SNP type to calculate a composite score, resulting in an “Overall SNP Score” on a scale from 0 to 1, increasing in fixed increments of 1/3.

Medigap High-Deductible Plan G Offered

We scored providers that offered Medigap high-deductible plan G on a binary scale of 0 for no and 1 for yes. 

Types of Medigap Plans Offered

We scored companies based on how many types of Medicare supplement plans (i.e., A, B, C, D, F, G, K, L, M, N, and high-deductible F and G) were offered by each company. We scored this criterion on a range from 0 to 1, in fixed increments of 1 out of 12, 12 being the total number of plans (10 regular plans and two high-deductible plans).

Cost

We measured cost competitiveness for Medicare Advantage and standalone Part D plans in two ways. This information is especially important for beneficiaries with fixed incomes or limited financial resources. First, we used public data from CMS to calculate averages for the following cost criteria across all plans offered nationwide:

• Premiums (MA and Part D)
• Drug deductible (MA and Part D)
• Health deductible (MA)
• Out-of-pocket max (OOP) (MA)

For Medicare Advantage and Part D, we also looked at the percentage of plans with $0 premiums. Once we gathered this information for every company, we scored each on a continuous scale from 0 to 1.

To better understand copays and drug pricing for each company, we collected quotes across at least two ZIP codes. For Medicare Advantage plans, we collected the following data points about plans with the lowest in-network out-of-pocket costs:

• Plan name
• In-network, out-of-pocket maximum
• Premium
• Health/drug Deductibles
• Overall CAHPS star rating
• Primary care copay
• Specialist copay
• Yearly cost of Atorvastatin (Walgreens and CVS)
• Yearly cost of Ozempic (Walgreens and CVS)
• Yearly cost of Lenalidomide/chemotherapy drug (Walgreens and CVS)

Drug Prices

We collected prices for four drugs at two major national pharmacies because these costs can vary significantly between plans. We chose a variety of drugs to reflect a range of expenses consumers may face:

• Atorvastatin: The brand name is Lipitor, and it’s one of the most commonly prescribed drugs in the U.S. It helps improve cholesterol levels. We got prices for the generic version.
• Ozempic: Semaglutides, a class of weight loss drugs that brand names like Ozempic belong to, topped the list of most popular drugs by spending in 2023. We included this drug because of the high consumer demand for it.
• Lenalidomide: We included lenalidomide, brand name Revlimid, to account for consumers needing cancer treatment. Lenalidomide treats certain types of blood cancer. We got prices for the generic version.
• Lisinopril: This is another of the most commonly prescribed drugs in the U.S., and it is a popular treatment for high blood pressure.

For Part D, we collected the following for the plan with the lowest premium in four sample ZIP codes for each company:

• Plan name
• Premium
• Drug deductible
• Copay during initial coverage phase
• Copay during catastrophic coverage phase
• Yearly cost of Lisinopril (Walgreens and CVS)
• Yearly cost of Atorvastatin (Walgreens and CVS)
• Yearly cost of Ozempic (Walgreens and CVS)
• Yearly cost of Lenalidomide/chemotherapy drug (Walgreens and CVS)

For Medicare supplement/Medigap plans, we collected monthly costs for Plan F, Plan G, and Plan G-high deductible in Florida and Texas for 70- and 80-year-old men and women.

Monthly Premium

We looked at the premium for each provider’s plan (and averaged multiple premiums for Blue Cross Blue Shields’ various companies). Premiums were then scored on a continuous scale, with the lowest cost earning a 1 and the highest a 0. Every other premium scored somewhere in between at non-fixed intervals. We looked at premiums for the specific ZIP codes as well as nationwide cost data.

Out-of-Pocket Maximum

This is the total dollar amount paid in copays and coinsurance before a plan pays for 100% of covered health insurance services. We scored this on a continuous scale in which the lowest cost was awarded 1 and the higher costs were scored at non-fixed intervals such that 0 was the score for the highest cost. We looked at out-of-pocket maximums for the specific ZIP codes as well as nationwide cost data.

Drug Deductible 

We scored this on a continuous scale in which the lowest cost was awarded 1 and the highest cost received a 0, with every other score falling between at non-fixed intervals. We looked at deductibles for the specific ZIP codes as well as nationwide cost data.

Extra Benefits Available

We measured whether Medicare Advantage companies offered the following eight plan benefits: vision, dental, hearing, transportation, fitness, worldwide emergency care, nurse helpline, and telehealth. We awarded 1 point for each benefit, up to 8. These additional services can enhance the health care experience for consumers and add value to their medical coverage.

Availability

State Availability

This measure indicates how widely a plan is available across the U.S. Wider availability ensures greater access and flexibility for consumers, especially if they move or travel frequently. We scored this on a continuous scale from 0 to 1, with UnitedHealthcare, Aetna, and Human receiving the highest score of 1 (available in 49 states), and Molina receiving a score of 0 (available in 2 states).

Network Size

This measure refers to the number of health care providers, such as doctors, hospitals, and pharmacies, that are included in the health plan’s network. A larger network typically offers more choices for patients. For each company, we collected data on the size of the provider network. This was scored on a continuous scale: The company with the largest network received a score of 1, while the company with the smallest network received a score of 0. 

Financial Strength

We looked at AM Best ratings for each company to determine its financial strength. A high AM Best rating indicates a company is financially secure and capable of meeting its financial obligations, such as paying claims regularly. We only weighted Medigap companies that had at least an A- rating. We used a scaled scoring system for this criterion. There are 13 possible AM best grades, with A++ the highest, and D the lowest. Scores were assigned in fixed increments of 0.0769 as shown below:

• A++ Rating: 1
• A+ Rating: 0.923
• A Rating: 0.846
• A- : 0.769
• B++: 0.692
• B+: 0.615
• B: 0.538
• B-: 0.462
• C++: 0.385
• C+: 0.308
• C: 0.231
• C-: 0.154
• D: 0.077

Articles That Use Our Methodology

We have many articles about the best Medicare insurance companies for specific products or to meet the needs of particular readers. The research conducted and data collected to create this methodology have been used to compile our list of the Best Medicare Advantage Plans. Other articles that list the best Medicare insurance companies for certain products or readers (for example, Best Medicare Supplement (Medigap) Insurance, Best Medicare Supplement Plan G Providers, Best Medicare Supplement Plan F Providers or Best Medicare Part D Plans) rely on information collected as part of the grading process described here. But selections and order of providers are based on additional product-specific criteria plus subjective insights from our editors and industry experts.

Meet the Research Team

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