Medicare Ratings Guide

Author: Dr. Patricia Chen

  • Medicaid Eligibility in Arkansas 2026: Income Limits, Requirements & How to Apply

    Medicaid in Arkansas: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $1,064/month $1,596/month
    ACA Expansion (working-age adults) 138% FPL = $1,831/month 138% FPL = $2,480/month

    Medicaid Expansion Status in Arkansas

    Arkansas has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage.

    Who Qualifies for Medicaid in Arkansas?

    Medicaid in Arkansas covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (if the state has expanded Medicaid).

    Medicaid for Seniors (65+) in Arkansas

    Seniors in Arkansas may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in Arkansas is $1,064/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in Arkansas

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in Arkansas. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $1,064/month.

    How to Apply for Medicaid in Arkansas

    You can apply for Medicaid in Arkansas through the following channels:

    • Online: Through Arkansas’s state Medicaid portal or HealthCare.gov
    • Phone: Call Arkansas’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in Arkansas

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In Arkansas, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 122,400 dual-eligible individuals in Arkansas.

    Medicaid Asset Limits in Arkansas

    In addition to income limits, Medicaid for long-term care in Arkansas has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicaid Eligibility in Arizona 2026: Income Limits, Requirements & How to Apply

    Medicaid in Arizona: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $1,330/month $1,995/month
    ACA Expansion (working-age adults) 138% FPL = $1,831/month 138% FPL = $2,480/month

    Medicaid Expansion Status in Arizona

    Arizona has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage.

    Who Qualifies for Medicaid in Arizona?

    Medicaid in Arizona covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (if the state has expanded Medicaid).

    Medicaid for Seniors (65+) in Arizona

    Seniors in Arizona may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in Arizona is $1,330/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in Arizona

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in Arizona. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $1,330/month.

    How to Apply for Medicaid in Arizona

    You can apply for Medicaid in Arizona through the following channels:

    • Online: Through Arizona’s state Medicaid portal or HealthCare.gov
    • Phone: Call Arizona’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in Arizona

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In Arizona, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 237,600 dual-eligible individuals in Arizona.

    Medicaid Asset Limits in Arizona

    In addition to income limits, Medicaid for long-term care in Arizona has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicaid Eligibility in Alaska 2026: Income Limits, Requirements & How to Apply

    Medicaid in Alaska: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $1,845/month $2,768/month
    ACA Expansion (working-age adults) 138% FPL = $1,831/month 138% FPL = $2,480/month

    Medicaid Expansion Status in Alaska

    Alaska has fully expanded Medicaid under the Affordable Care Act, meaning adults earning up to 138% of the Federal Poverty Level ($22,025/year for an individual) qualify for Medicaid coverage.

    Who Qualifies for Medicaid in Alaska?

    Medicaid in Alaska covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (if the state has expanded Medicaid).

    Medicaid for Seniors (65+) in Alaska

    Seniors in Alaska may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in Alaska is $1,845/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in Alaska

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in Alaska. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $1,845/month.

    How to Apply for Medicaid in Alaska

    You can apply for Medicaid in Alaska through the following channels:

    • Online: Through Alaska’s state Medicaid portal or HealthCare.gov
    • Phone: Call Alaska’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in Alaska

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In Alaska, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 17,100 dual-eligible individuals in Alaska.

    Medicaid Asset Limits in Alaska

    In addition to income limits, Medicaid for long-term care in Alaska has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicaid Eligibility in Alabama 2026: Income Limits, Requirements & How to Apply

    Medicaid in Alabama: 2026 Income Limits

    Medicaid Program Single Person Married Couple
    Nursing Home / Institutional Medicaid $2,982/month $5,964/month
    HCBS Waiver (home-based care) $2,982/month $5,964/month
    Regular Medicaid (Aged, Blind, Disabled) $1,014/month $1,521/month
    ACA Expansion (working-age adults) Not available (state not expanded) Not available

    Medicaid Expansion Status in Alabama

    Alabama has not expanded Medicaid, meaning most adults without dependent children do not qualify for Medicaid regardless of income. Only parents earning up to 18% FPL ($4,918/year for a family of three) may qualify.

    Who Qualifies for Medicaid in Alabama?

    Medicaid in Alabama covers several distinct groups, each with different income and eligibility requirements. The major categories are: seniors (65+), people with disabilities, pregnant women, children, and low-income adults (limited eligibility in non-expansion states).

    Medicaid for Seniors (65+) in Alabama

    Seniors in Alabama may qualify for Medicaid to cover nursing home care, home-based care, or to supplement Medicare coverage. The income limit for Regular Medicaid (Aged, Blind, and Disabled) in Alabama is $1,014/month for a single person. For nursing home care, the limit is $2,982/month.

    Medicaid for People with Disabilities in Alabama

    People with disabilities who receive SSDI or SSI may qualify for Medicaid in Alabama. SSI recipients automatically qualify for Medicaid in most states. SSDI recipients must wait 24 months for Medicare, during which Medicaid may provide coverage if income is below $1,014/month.

    How to Apply for Medicaid in Alabama

    You can apply for Medicaid in Alabama through the following channels:

    • Online: Through Alabama’s state Medicaid portal or HealthCare.gov
    • Phone: Call Alabama’s Medicaid office directly
    • In person: Visit your local Department of Social Services or Medicaid office
    • Mail: Download and mail a paper application

    Medicaid and Medicare Dual Eligibility in Alabama

    Individuals who qualify for both Medicare and Medicaid are called “dual eligibles.” In Alabama, dual eligible individuals receive comprehensive coverage: Medicare covers most medical services, while Medicaid covers Medicare premiums, deductibles, copays, and additional services like long-term care. There are approximately 189,000 dual-eligible individuals in Alabama.

    Medicaid Asset Limits in Alabama

    In addition to income limits, Medicaid for long-term care in Alabama has asset limits. For a single applicant, the countable asset limit is typically $2,000. For a married couple where one spouse needs nursing home care, the community spouse may keep up to $157,920 in countable assets (the Community Spouse Resource Allowance, or CSRA, for 2026). The primary home, one vehicle, personal belongings, and certain other assets are typically exempt.

  • Medicare Advantage Plans in District of Columbia 2026: Ratings, Costs & Best Plans

    Medicare Advantage in District of Columbia: 2026 At a Glance

    Total MA Plans Available 8
    Average Monthly Premium $22.40/month
    Average CMS Star Rating 4.2 / 5.0 stars
    Part D Plans (standalone) 18
    Medicare Beneficiaries in State 98,000

    How Medicare Advantage Works in District of Columbia

    Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers approved by CMS. In District of Columbia, there are 8 Medicare Advantage plans available, with an average CMS star rating of 4.2 out of 5.0. Unlike Original Medicare, most MA plans include prescription drug coverage (MAPD), dental, vision, and hearing benefits, often at a lower out-of-pocket cost for people who stay in-network.

    CMS Star Ratings for District of Columbia Medicare Advantage Plans

    CMS evaluates every Medicare Advantage plan annually on 40+ quality measures and assigns a star rating from 1 to 5. Plans rated 4 stars or higher receive quality bonus payments, which insurers typically pass on to enrollees through lower premiums or richer benefits. The average MA plan in District of Columbia is rated 4.2 stars.

    What CMS Star Ratings Measure

    Category Weight Examples
    Managing Chronic Conditions High Diabetes control, blood pressure management, cholesterol screening
    Member Experience High Getting needed care, getting appointments, customer service
    Preventive Care Medium Flu shots, cancer screenings, medication adherence
    Health Plan Administration Medium Appeals decisions, call center performance
    Drug Plan Quality (if MAPD) Medium Drug pricing accuracy, formulary accuracy

    Types of Medicare Advantage Plans in District of Columbia

    Plan Type Network Referrals Required Out-of-Network Coverage
    HMO (Health Maintenance Organization) Restricted network Yes (for specialists) Emergency only
    PPO (Preferred Provider Organization) Preferred + out-of-network No Yes (higher cost)
    PFFS (Private Fee-for-Service) Any provider accepting plan terms No Yes (if provider accepts)
    SNP (Special Needs Plan) Varies Varies Limited

    2026 Medicare Advantage Enrollment Periods in District of Columbia

    Period Dates What You Can Do
    Annual Enrollment Period (AEP) Oct 15 – Dec 7 Switch plans, join, or drop MA
    Medicare Advantage Open Enrollment Jan 1 – Mar 31 Switch MA plans or return to Original Medicare
    Initial Enrollment Period 3 months before to 3 months after turning 65 First-time enrollment
    Special Enrollment Period Varies by qualifying event Moving, losing other coverage, etc.

    Medicare Advantage vs. Original Medicare in District of Columbia

    Feature Original Medicare Medicare Advantage
    Monthly premium Part B: $185/month (2026) $22.40/month (average in District of Columbia)
    Annual out-of-pocket max No limit Capped (varies by plan)
    Prescription drugs Separate Part D plan required Usually included (MAPD)
    Dental/vision/hearing Not covered Usually included
    Provider choice Any Medicare provider nationwide Network restrictions apply
    Prior authorization Rarely required Common for specialist visits and procedures
    Star rating N/A Average 4.2 stars in District of Columbia

    How to Choose a Medicare Advantage Plan in District of Columbia

    When comparing Medicare Advantage plans in District of Columbia, prioritize these factors in order: (1) whether your current doctors and preferred hospitals are in-network, (2) whether your current prescriptions are on the plan formulary at a reasonable tier, (3) the plan’s CMS star rating — aim for 4 stars or higher, (4) the annual out-of-pocket maximum, and (5) any extra benefits like dental or vision that you’ll actually use. Use the Medicare Plan Finder at medicare.gov/plan-compare to compare all 8 plans available in your ZIP code.

  • Medicare Advantage Plans in Wyoming 2026: Ratings, Costs & Best Plans

    Medicare Advantage in Wyoming: 2026 At a Glance

    Total MA Plans Available 4
    Average Monthly Premium $0/month
    Average CMS Star Rating 3.5 / 5.0 stars
    Part D Plans (standalone) 18
    Medicare Beneficiaries in State 120,000

    How Medicare Advantage Works in Wyoming

    Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers approved by CMS. In Wyoming, there are 4 Medicare Advantage plans available, with an average CMS star rating of 3.5 out of 5.0. Unlike Original Medicare, most MA plans include prescription drug coverage (MAPD), dental, vision, and hearing benefits, often at a lower out-of-pocket cost for people who stay in-network.

    CMS Star Ratings for Wyoming Medicare Advantage Plans

    CMS evaluates every Medicare Advantage plan annually on 40+ quality measures and assigns a star rating from 1 to 5. Plans rated 4 stars or higher receive quality bonus payments, which insurers typically pass on to enrollees through lower premiums or richer benefits. The average MA plan in Wyoming is rated 3.5 stars.

    What CMS Star Ratings Measure

    Category Weight Examples
    Managing Chronic Conditions High Diabetes control, blood pressure management, cholesterol screening
    Member Experience High Getting needed care, getting appointments, customer service
    Preventive Care Medium Flu shots, cancer screenings, medication adherence
    Health Plan Administration Medium Appeals decisions, call center performance
    Drug Plan Quality (if MAPD) Medium Drug pricing accuracy, formulary accuracy

    Types of Medicare Advantage Plans in Wyoming

    Plan Type Network Referrals Required Out-of-Network Coverage
    HMO (Health Maintenance Organization) Restricted network Yes (for specialists) Emergency only
    PPO (Preferred Provider Organization) Preferred + out-of-network No Yes (higher cost)
    PFFS (Private Fee-for-Service) Any provider accepting plan terms No Yes (if provider accepts)
    SNP (Special Needs Plan) Varies Varies Limited

    2026 Medicare Advantage Enrollment Periods in Wyoming

    Period Dates What You Can Do
    Annual Enrollment Period (AEP) Oct 15 – Dec 7 Switch plans, join, or drop MA
    Medicare Advantage Open Enrollment Jan 1 – Mar 31 Switch MA plans or return to Original Medicare
    Initial Enrollment Period 3 months before to 3 months after turning 65 First-time enrollment
    Special Enrollment Period Varies by qualifying event Moving, losing other coverage, etc.

    Medicare Advantage vs. Original Medicare in Wyoming

    Feature Original Medicare Medicare Advantage
    Monthly premium Part B: $185/month (2026) $0/month (average in Wyoming)
    Annual out-of-pocket max No limit Capped (varies by plan)
    Prescription drugs Separate Part D plan required Usually included (MAPD)
    Dental/vision/hearing Not covered Usually included
    Provider choice Any Medicare provider nationwide Network restrictions apply
    Prior authorization Rarely required Common for specialist visits and procedures
    Star rating N/A Average 3.5 stars in Wyoming

    How to Choose a Medicare Advantage Plan in Wyoming

    When comparing Medicare Advantage plans in Wyoming, prioritize these factors in order: (1) whether your current doctors and preferred hospitals are in-network, (2) whether your current prescriptions are on the plan formulary at a reasonable tier, (3) the plan’s CMS star rating — aim for 4 stars or higher, (4) the annual out-of-pocket maximum, and (5) any extra benefits like dental or vision that you’ll actually use. Use the Medicare Plan Finder at medicare.gov/plan-compare to compare all 4 plans available in your ZIP code.

  • Medicare Advantage Plans in Wisconsin 2026: Ratings, Costs & Best Plans

    Medicare Advantage in Wisconsin: 2026 At a Glance

    Total MA Plans Available 38
    Average Monthly Premium $10.20/month
    Average CMS Star Rating 4.0 / 5.0 stars
    Part D Plans (standalone) 23
    Medicare Beneficiaries in State 1,280,000

    How Medicare Advantage Works in Wisconsin

    Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers approved by CMS. In Wisconsin, there are 38 Medicare Advantage plans available, with an average CMS star rating of 4.0 out of 5.0. Unlike Original Medicare, most MA plans include prescription drug coverage (MAPD), dental, vision, and hearing benefits, often at a lower out-of-pocket cost for people who stay in-network.

    CMS Star Ratings for Wisconsin Medicare Advantage Plans

    CMS evaluates every Medicare Advantage plan annually on 40+ quality measures and assigns a star rating from 1 to 5. Plans rated 4 stars or higher receive quality bonus payments, which insurers typically pass on to enrollees through lower premiums or richer benefits. The average MA plan in Wisconsin is rated 4.0 stars.

    What CMS Star Ratings Measure

    Category Weight Examples
    Managing Chronic Conditions High Diabetes control, blood pressure management, cholesterol screening
    Member Experience High Getting needed care, getting appointments, customer service
    Preventive Care Medium Flu shots, cancer screenings, medication adherence
    Health Plan Administration Medium Appeals decisions, call center performance
    Drug Plan Quality (if MAPD) Medium Drug pricing accuracy, formulary accuracy

    Types of Medicare Advantage Plans in Wisconsin

    Plan Type Network Referrals Required Out-of-Network Coverage
    HMO (Health Maintenance Organization) Restricted network Yes (for specialists) Emergency only
    PPO (Preferred Provider Organization) Preferred + out-of-network No Yes (higher cost)
    PFFS (Private Fee-for-Service) Any provider accepting plan terms No Yes (if provider accepts)
    SNP (Special Needs Plan) Varies Varies Limited

    2026 Medicare Advantage Enrollment Periods in Wisconsin

    Period Dates What You Can Do
    Annual Enrollment Period (AEP) Oct 15 – Dec 7 Switch plans, join, or drop MA
    Medicare Advantage Open Enrollment Jan 1 – Mar 31 Switch MA plans or return to Original Medicare
    Initial Enrollment Period 3 months before to 3 months after turning 65 First-time enrollment
    Special Enrollment Period Varies by qualifying event Moving, losing other coverage, etc.

    Medicare Advantage vs. Original Medicare in Wisconsin

    Feature Original Medicare Medicare Advantage
    Monthly premium Part B: $185/month (2026) $10.20/month (average in Wisconsin)
    Annual out-of-pocket max No limit Capped (varies by plan)
    Prescription drugs Separate Part D plan required Usually included (MAPD)
    Dental/vision/hearing Not covered Usually included
    Provider choice Any Medicare provider nationwide Network restrictions apply
    Prior authorization Rarely required Common for specialist visits and procedures
    Star rating N/A Average 4.0 stars in Wisconsin

    How to Choose a Medicare Advantage Plan in Wisconsin

    When comparing Medicare Advantage plans in Wisconsin, prioritize these factors in order: (1) whether your current doctors and preferred hospitals are in-network, (2) whether your current prescriptions are on the plan formulary at a reasonable tier, (3) the plan’s CMS star rating — aim for 4 stars or higher, (4) the annual out-of-pocket maximum, and (5) any extra benefits like dental or vision that you’ll actually use. Use the Medicare Plan Finder at medicare.gov/plan-compare to compare all 38 plans available in your ZIP code.

  • Medicare Advantage Plans in West Virginia 2026: Ratings, Costs & Best Plans

    Medicare Advantage in West Virginia: 2026 At a Glance

    Total MA Plans Available 16
    Average Monthly Premium $5.80/month
    Average CMS Star Rating 3.6 / 5.0 stars
    Part D Plans (standalone) 21
    Medicare Beneficiaries in State 480,000

    How Medicare Advantage Works in West Virginia

    Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers approved by CMS. In West Virginia, there are 16 Medicare Advantage plans available, with an average CMS star rating of 3.6 out of 5.0. Unlike Original Medicare, most MA plans include prescription drug coverage (MAPD), dental, vision, and hearing benefits, often at a lower out-of-pocket cost for people who stay in-network.

    CMS Star Ratings for West Virginia Medicare Advantage Plans

    CMS evaluates every Medicare Advantage plan annually on 40+ quality measures and assigns a star rating from 1 to 5. Plans rated 4 stars or higher receive quality bonus payments, which insurers typically pass on to enrollees through lower premiums or richer benefits. The average MA plan in West Virginia is rated 3.6 stars.

    What CMS Star Ratings Measure

    Category Weight Examples
    Managing Chronic Conditions High Diabetes control, blood pressure management, cholesterol screening
    Member Experience High Getting needed care, getting appointments, customer service
    Preventive Care Medium Flu shots, cancer screenings, medication adherence
    Health Plan Administration Medium Appeals decisions, call center performance
    Drug Plan Quality (if MAPD) Medium Drug pricing accuracy, formulary accuracy

    Types of Medicare Advantage Plans in West Virginia

    Plan Type Network Referrals Required Out-of-Network Coverage
    HMO (Health Maintenance Organization) Restricted network Yes (for specialists) Emergency only
    PPO (Preferred Provider Organization) Preferred + out-of-network No Yes (higher cost)
    PFFS (Private Fee-for-Service) Any provider accepting plan terms No Yes (if provider accepts)
    SNP (Special Needs Plan) Varies Varies Limited

    2026 Medicare Advantage Enrollment Periods in West Virginia

    Period Dates What You Can Do
    Annual Enrollment Period (AEP) Oct 15 – Dec 7 Switch plans, join, or drop MA
    Medicare Advantage Open Enrollment Jan 1 – Mar 31 Switch MA plans or return to Original Medicare
    Initial Enrollment Period 3 months before to 3 months after turning 65 First-time enrollment
    Special Enrollment Period Varies by qualifying event Moving, losing other coverage, etc.

    Medicare Advantage vs. Original Medicare in West Virginia

    Feature Original Medicare Medicare Advantage
    Monthly premium Part B: $185/month (2026) $5.80/month (average in West Virginia)
    Annual out-of-pocket max No limit Capped (varies by plan)
    Prescription drugs Separate Part D plan required Usually included (MAPD)
    Dental/vision/hearing Not covered Usually included
    Provider choice Any Medicare provider nationwide Network restrictions apply
    Prior authorization Rarely required Common for specialist visits and procedures
    Star rating N/A Average 3.6 stars in West Virginia

    How to Choose a Medicare Advantage Plan in West Virginia

    When comparing Medicare Advantage plans in West Virginia, prioritize these factors in order: (1) whether your current doctors and preferred hospitals are in-network, (2) whether your current prescriptions are on the plan formulary at a reasonable tier, (3) the plan’s CMS star rating — aim for 4 stars or higher, (4) the annual out-of-pocket maximum, and (5) any extra benefits like dental or vision that you’ll actually use. Use the Medicare Plan Finder at medicare.gov/plan-compare to compare all 16 plans available in your ZIP code.

  • Medicare Advantage Plans in Washington 2026: Ratings, Costs & Best Plans

    Medicare Advantage in Washington: 2026 At a Glance

    Total MA Plans Available 38
    Average Monthly Premium $11.60/month
    Average CMS Star Rating 4.1 / 5.0 stars
    Part D Plans (standalone) 24
    Medicare Beneficiaries in State 1,480,000

    How Medicare Advantage Works in Washington

    Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers approved by CMS. In Washington, there are 38 Medicare Advantage plans available, with an average CMS star rating of 4.1 out of 5.0. Unlike Original Medicare, most MA plans include prescription drug coverage (MAPD), dental, vision, and hearing benefits, often at a lower out-of-pocket cost for people who stay in-network.

    CMS Star Ratings for Washington Medicare Advantage Plans

    CMS evaluates every Medicare Advantage plan annually on 40+ quality measures and assigns a star rating from 1 to 5. Plans rated 4 stars or higher receive quality bonus payments, which insurers typically pass on to enrollees through lower premiums or richer benefits. The average MA plan in Washington is rated 4.1 stars.

    What CMS Star Ratings Measure

    Category Weight Examples
    Managing Chronic Conditions High Diabetes control, blood pressure management, cholesterol screening
    Member Experience High Getting needed care, getting appointments, customer service
    Preventive Care Medium Flu shots, cancer screenings, medication adherence
    Health Plan Administration Medium Appeals decisions, call center performance
    Drug Plan Quality (if MAPD) Medium Drug pricing accuracy, formulary accuracy

    Types of Medicare Advantage Plans in Washington

    Plan Type Network Referrals Required Out-of-Network Coverage
    HMO (Health Maintenance Organization) Restricted network Yes (for specialists) Emergency only
    PPO (Preferred Provider Organization) Preferred + out-of-network No Yes (higher cost)
    PFFS (Private Fee-for-Service) Any provider accepting plan terms No Yes (if provider accepts)
    SNP (Special Needs Plan) Varies Varies Limited

    2026 Medicare Advantage Enrollment Periods in Washington

    Period Dates What You Can Do
    Annual Enrollment Period (AEP) Oct 15 – Dec 7 Switch plans, join, or drop MA
    Medicare Advantage Open Enrollment Jan 1 – Mar 31 Switch MA plans or return to Original Medicare
    Initial Enrollment Period 3 months before to 3 months after turning 65 First-time enrollment
    Special Enrollment Period Varies by qualifying event Moving, losing other coverage, etc.

    Medicare Advantage vs. Original Medicare in Washington

    Feature Original Medicare Medicare Advantage
    Monthly premium Part B: $185/month (2026) $11.60/month (average in Washington)
    Annual out-of-pocket max No limit Capped (varies by plan)
    Prescription drugs Separate Part D plan required Usually included (MAPD)
    Dental/vision/hearing Not covered Usually included
    Provider choice Any Medicare provider nationwide Network restrictions apply
    Prior authorization Rarely required Common for specialist visits and procedures
    Star rating N/A Average 4.1 stars in Washington

    How to Choose a Medicare Advantage Plan in Washington

    When comparing Medicare Advantage plans in Washington, prioritize these factors in order: (1) whether your current doctors and preferred hospitals are in-network, (2) whether your current prescriptions are on the plan formulary at a reasonable tier, (3) the plan’s CMS star rating — aim for 4 stars or higher, (4) the annual out-of-pocket maximum, and (5) any extra benefits like dental or vision that you’ll actually use. Use the Medicare Plan Finder at medicare.gov/plan-compare to compare all 38 plans available in your ZIP code.

  • Medicare Advantage Plans in Virginia 2026: Ratings, Costs & Best Plans

    Medicare Advantage in Virginia: 2026 At a Glance

    Total MA Plans Available 44
    Average Monthly Premium $10.80/month
    Average CMS Star Rating 4.0 / 5.0 stars
    Part D Plans (standalone) 24
    Medicare Beneficiaries in State 1,680,000

    How Medicare Advantage Works in Virginia

    Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurers approved by CMS. In Virginia, there are 44 Medicare Advantage plans available, with an average CMS star rating of 4.0 out of 5.0. Unlike Original Medicare, most MA plans include prescription drug coverage (MAPD), dental, vision, and hearing benefits, often at a lower out-of-pocket cost for people who stay in-network.

    CMS Star Ratings for Virginia Medicare Advantage Plans

    CMS evaluates every Medicare Advantage plan annually on 40+ quality measures and assigns a star rating from 1 to 5. Plans rated 4 stars or higher receive quality bonus payments, which insurers typically pass on to enrollees through lower premiums or richer benefits. The average MA plan in Virginia is rated 4.0 stars.

    What CMS Star Ratings Measure

    Category Weight Examples
    Managing Chronic Conditions High Diabetes control, blood pressure management, cholesterol screening
    Member Experience High Getting needed care, getting appointments, customer service
    Preventive Care Medium Flu shots, cancer screenings, medication adherence
    Health Plan Administration Medium Appeals decisions, call center performance
    Drug Plan Quality (if MAPD) Medium Drug pricing accuracy, formulary accuracy

    Types of Medicare Advantage Plans in Virginia

    Plan Type Network Referrals Required Out-of-Network Coverage
    HMO (Health Maintenance Organization) Restricted network Yes (for specialists) Emergency only
    PPO (Preferred Provider Organization) Preferred + out-of-network No Yes (higher cost)
    PFFS (Private Fee-for-Service) Any provider accepting plan terms No Yes (if provider accepts)
    SNP (Special Needs Plan) Varies Varies Limited

    2026 Medicare Advantage Enrollment Periods in Virginia

    Period Dates What You Can Do
    Annual Enrollment Period (AEP) Oct 15 – Dec 7 Switch plans, join, or drop MA
    Medicare Advantage Open Enrollment Jan 1 – Mar 31 Switch MA plans or return to Original Medicare
    Initial Enrollment Period 3 months before to 3 months after turning 65 First-time enrollment
    Special Enrollment Period Varies by qualifying event Moving, losing other coverage, etc.

    Medicare Advantage vs. Original Medicare in Virginia

    Feature Original Medicare Medicare Advantage
    Monthly premium Part B: $185/month (2026) $10.80/month (average in Virginia)
    Annual out-of-pocket max No limit Capped (varies by plan)
    Prescription drugs Separate Part D plan required Usually included (MAPD)
    Dental/vision/hearing Not covered Usually included
    Provider choice Any Medicare provider nationwide Network restrictions apply
    Prior authorization Rarely required Common for specialist visits and procedures
    Star rating N/A Average 4.0 stars in Virginia

    How to Choose a Medicare Advantage Plan in Virginia

    When comparing Medicare Advantage plans in Virginia, prioritize these factors in order: (1) whether your current doctors and preferred hospitals are in-network, (2) whether your current prescriptions are on the plan formulary at a reasonable tier, (3) the plan’s CMS star rating — aim for 4 stars or higher, (4) the annual out-of-pocket maximum, and (5) any extra benefits like dental or vision that you’ll actually use. Use the Medicare Plan Finder at medicare.gov/plan-compare to compare all 44 plans available in your ZIP code.