Typical Cost Per Visit ?
—
Median — most representative
Average Cost Per Visit ?
—
Can be higher due to outliers
💊 2027 Drug Savings
15 drugs negotiated
Includes Ozempic & Wegovy · Savings start Jan 2027
⚡ Faster Approvals Coming
New federal rules
All plans must speed up prior auth by Jan 2027
📍 State Coverage
All 50 states
Filter by your state using the selector below
🏥 Care Settings
30 settings
Clinic, home health, hospital & more
Medicare Advantage
Medicare FFS
Medicaid
Dual Enrollment
Commercial
Qualify for both Medicare and Medicaid?
You may be eligible for a Dual Special Needs Plan (D-SNP) — built for people who have both. Lower out-of-pocket costs, better care coordination. Look for the Dual Enrollment row below.
How plans stack up
Ranked by median cost per claim · 2024 real-world data · filter by state or care setting above
The real cost of each plan type
Median cost is the more honest number — a small number of very expensive claims can pull the average way up
| Plan Type | Median Cost | Avg Cost | Low (P25) | Typical (P75) | High (P90) | Cost / Patient | Patients |
|---|
Median vs. average — why it matters
A big gap means outliers are distorting the picture
Cost spread — what to expect
Narrower range = more predictable monthly costs
What each plan costs per person
Total billed charges ÷ unique patients — the closest thing to a true annual cost comparison
Search by your condition
Choose your condition below to see which plan type has the best cost and fastest approvals for patients like you.
How quickly will your care get approved?
This shows how many days it typically takes for your plan to approve a care request. Under 7 days is the goal. New federal rules starting Jan 2027 will require all plans to move faster.
How quickly are requests approved?
% of claims processed in each timeframe — more green means faster access
Delays over 2 weeks — by plan
When a claim takes 14+ days, patients often can't get the care they need
Browse specific plans
Sorted by patient volume · PA speed: Fast ≤7d OK 8–14d Slow >14d
| Plan Name | Type | State | Claims | Patients | Avg Cost | Median Cost | PA Lag | Conditions | Services |
|---|
How costs moved through 2024
Average charge per claim each month — seasonal spikes and mid-year repricing show up here
When people use care most
Claim volume by month — higher volume months signal seasonal health patterns
Does age change your costs?
Cost by age bracket and plan — see where you fall relative to others
What's changing in 2027 — and what it means for you
Eight reforms hitting in 2026–2027. Here's what each one actually means for your plan choice.
IRA · 2027
Drug Price Negotiation
15 drugs negotiated including GLP-1s. ~$685M in projected patient savings. Check if your drug is on the list.
MAFFS
MA · 2027
MA Payment Pressure
Only 0.09% MA payment increase proposed. Risk of benefit reductions or plan exits. Verify your 2027 benefits Oct–Dec 2026.
MA
CMS · Oct 2026
GLOBE Pilot (Part B)
International price benchmarks for Part B drugs. Only a subset of drugs and providers participate — ask your doctor.
FFSMA
CMS · Jan 2027
GUARD Pilot (Part D)
Part D pricing pilot. Not broad enough to replace plan shopping — still compare formularies carefully.
MAFFS
AHIP · Jan 2027
e-Prior Authorization
Standardized electronic PA required across all plans. Expect faster approvals — ask your plan about their timeline.
All Plans
CMS · Medicaid
State Pricing Model
Optional state program aligning Medicaid prices with peer countries. Check your state's participation.
MedicaidDual
CMS · Medicaid
Cell & Gene Therapy
Outcomes-based access for sickle cell and rare diseases. State participation varies — ask if your condition qualifies.
MedicaidDual
Dual · 2027
D-SNP Coordination
Dual Special Needs Plans must improve care coordination by 2027. If you have both, ask about D-SNP options now.
Dual Enrollment
Medicare open enrollment checklist
Five questions to answer before locking in your 2027 plan
Q1 Is my drug on the 2027 negotiated list?
Q2 Should I stay in MA or switch to traditional Medicare + Part D?
Q3 Will my premium increase even if drug prices come down?
Q4 Which plan has the least prior auth friction for my therapy?
Q★ Do I qualify for Dual Enrollment (D-SNP)? Could I save more?
Medicaid & dual enrollment checklist
Five questions if you're on Medicaid or qualify for dual enrollment
Q7 Did my state join the new Medicaid drug-pricing model?
Q8 Will lower drug prices actually reduce my costs?
Q9 Will prior authorization get faster by 2027?
Q10 Does the gene therapy model apply to my condition?
Q★ Am I in a D-SNP? Is my plan improving care coordination for 2027?