Shopping overview

The HealthSherpa for Medicare Shopping page allows you to browse Medicare plans available in a particular zip code, with sorts and filters to help you select a plan:

Supported plans and carriers

We display plans across Medicare Advantage Prescription Drug (MAPD), Medicare Advantage (MA), Prescription Drug (Part D), Special Needs (SNP), and Med Supp.

We display nearly every carrier in our quoter, and over 50 carriers can be enrolled right through our site. View the full carrier list here.

Initiating shopping sessions

Starting a shopping session from a Contact's Details page:

To initiate a shopping session that's associated with a particular Contact, select the "Shop for [name]" button on the Contact Detail page:

This will launch a shopping associated with that particular Contact, whose name you'll see listed up top:

A Contact-associated shopping session will automatically pull these fields into the quoter (if you've already added them for the Contact):

ZIP code
Drug
Providers
Pharmacies
Extra Help / LIS eligibility setting

And if you edit any of these things during the Shopping session (i.e. adding a Drug), it will automatically update the Contact Detail.

Starting a shopping session from the ‘Shop plans’ button:

To initiate a shopping session that's not associated with any of your Contacts, select the blue ‘Shop plans’ button.

This will launch an anonymous shopping session with ‘Anon-[random digits]’ clearly visible at the top of the page.

During any anonymous shopping session, you can press the ‘Save’ button to associate the session with a Contact.

Note: An anonymous shopping session will remain active across tabs. To begin a fresh shopping session, select the ‘New session’ button.

Shopping session settings

Plan year

From October 1st – November 30th, a plan year filter will appear. During that time, the upcoming plan year will pre-populate but you may adjust this to the current year if needed.

Effective date

You may include or update the desired effective date for coverage using the ‘Effective date’ dropdown. Effective dates selected will pre-populate into the enrollment form.

Extra Help / Low Income Subsidy (LIS) level

The Extra Help / LIS data included on a Contact's Details page will automatically populate when initiating a shopping session from a Contact's Details page and may be updated if desired.

You may include or update Extra Help / LIS eligibility using the ‘Extra Help / LIS’ menu. Learn more about Extra Help / LIS here.

Note: As of January 1st 2024, there is only one level of Extra Help / LIS so the menu includes only Yes or No options. Selecting ‘Yes’ will apply the subsidy calculations to drug deductibles, drug copays, and plan premiums.

Shopping filters

You have access to many plan shopping filters when assisting consumers with plan selection. Notable filters available within shopping sessions include Drugs, Pharmacies, Providers, and Commissionable plans.

The "My appointed carriers" filter shows only those carriers you've added to your Carriers page. And this is one of a few filters that you can default to always being set, for any of the quotes you run. Access these defaults from your Settings page:

Drugs, Pharmacies, and Providers

Drugs, Pharmacies, and Providers included on a Contact's Details page will automatically populate when initiating a shopping session from a Contact's Details page and may be updated if desired.

Drugs

To add or edit drugs included in a shopping session, select ‘Add drugs’ under the ‘Drugs’ menu.

To add a drug, type in the name – after 3 characters are entered, search results will begin to populate. Customize dosage, quantity, and frequency, then press Save.

New: You can also use our new AI-powered feature to enter in multiple drugs all at once. Learn more here

Edit existing drugs by selecting the pencil icon next to the medication name. To remove an existing drug, select the ex icon next to the medication name.

Pharmacies

To add or edit Pharmacies included in a shopping session, select ‘Add pharmacies’ under the ‘Pharmacies’ menu.

This will launch a pop-up window. You may include up to three pharmacies in a given shopping session.

You may remove an existing pharmacy by selecting the ex icon next to the pharmacy name. To add a new retail pharmacy, simply key in the name of the pharmacy, a ZIP code, and ZIP code radius. You may adjust the search toggle to digital pharmacies to search available digital pharmacy options.

When you are done updating the pharmacy list, close the pop-up window to resume shopping.

Note: Shopping sessions without pre-selected pharmacies will have a default Retail and Mail Order pharmacy selected. Carriers may have unique defaults. Custom pharmacy selections will override defaults listed.

Providers

To add or edit Providers included in a shopping session, select ‘Add providers’ under the ‘Providers’ menu.

This will launch a pop-up window.

To add a new provider, first enter the name or NPI of the provider and search:

Select the provider, then select the location(s) your client sees them at. (If you don't see a location you're expecting, try expanding the search radius.)

A particular provider might be in a plan's network at one location, but not another. But don't worry, if the location you select isn't in network, we'll highlight locations that are in network – right here in the plan shopping view:

Note: You can also indicate if a provider is your client's Primary Care Provider (PCP). Doing so will pre-fill the Provider's information on enrollment forms, saving you the trouble of that data entry!

Plan cards

The HealthSherpa Medicare Shopping page includes plan cards which provide you with highlights of the coverage indicated.

Notable items housed within a plan card include:

Total costs est.: This estimate combines a plan's monthly premium with the cost of any drugs listed in the shopping session. Total cost estimates calculate estimated costs from the effective month of the plan through December of the plan year.
- Partial year: indicates that the Total costs estimate is accounting for only the remaining months in the year. To view the total costs estimate for a full year, select the ‘Details’ button from the plan card.
Drug costs est.: This is the estimated out-of-pocket costs for drugs you've listed in the shopping session. Drug cost estimates calculate estimated costs from the effective month of the plan through December of the plan year.
Drug tier information for drugs you've listed in the shopping session
The network status for any providers you've listed in the shopping session
Direct link to the plan’s benefits
Link to the plan Details page

Plan Details

The plan Details page gives you full plan information in an easy to browse format.

Notable fields within the Overview section include:

Total costs est.: This estimate combines a plan's monthly premium with the cost of any drugs listed in the shopping session. Total cost estimates calculate estimated costs from the effective month of the plan through December of the plan year.
- Partial year: indicates that the Total costs estimate is accounting for only the remaining months in the year. To view the total costs estimate for a full year, select the ‘Details’ button from the plan card.
Drug costs est.: This is the estimated out-of-pocket costs for drugs you've listed in the shopping session. Drug cost estimates calculate estimated costs from the effective month of the plan through December of the plan year.

The ‘Your drug costs’ section displays costs for drugs included within the shopping session. Prices displayed reflect the cost of filling a respective medication at the pharmacy selected within the shopping session, or the default pharmacy if no pharmacy was selected.

Notable items housed within the ‘Your drug costs’ section include:

Drug tiers
Indicators for prior authorization, step therapy, and quantity limits
Phased cost breakdowns
A monthly view to see how much the beneficiary will pay for all of their drugs on this plan for each of the remaining months of the year.

As you scroll, you will notice a much more granular view of the plan’s benefits.

Non-commissionable plans

For any plans that are non-commissionable, you'll see this red label on the Plan Card:

To hide non-commissionable plans, click the Commissionable filter:

And if you always want this filter set, for all quotes you run, you can set that in your Settings – see how here.

Suppressed plans

Some carriers restrict certain plans from being enrolled through any third-party platform, including HealthSherpa. These are called suppressed plans.

Suppressed plans still appear in our quoter and are marked with a yellow label. You can quote them normally, but enrollment must be completed using the carrier’s external process – which may be their broker portal, consumer site, Medicare.gov, or a paper application.

See how various carriers handle suppressed plans

Humana only allows suppressed Part D plans to be enrolled through their consumer site, or through Medicare.gov.
Anthem only allows suppressed plans to be submitted via paper application.
United only allows suppressed plans to be enrolled through their consumer site, or through Medicare.gov.

Note: Suppressed plans are different from non-commissionable plans – both types appear in our quoter, with distinct labels.

Enrollment

Ready to enroll? Learn more about our enrollment experience.

Frequently asked questions

Where does the plan, provider, and drug data come from?

This comes from our API integration with Connecture.

Do shared links to quotes expire?

Yes, if you share a link to a quote, it will expire after 90 days

Troubleshooting

I can't load any quotes

Check to see what the error message to determine resolution:

Maximum of 10 provider locations error: remove provider locations until there are 10 or fewer.
Maximum of 1 PCP error: you have more than 1 of this client's providers selected as PCP – edit their provider list to have just 1 be PCP.
Session expired error: Refresh the page – or, log out, open a new window, and log in.

If none of that fixes it, try logging out, opening a new window, and logging in. Or clearing cache/cookies. If all else fails, please contact Support.

I'm not seeing a plan I'd expect to see

Things to check in general
- Is it on the 2nd page of results? (by default there are 50 plans per page)
- Are you looking at the right Plan Year? (only relevant during Oct 7–Nov 30)
- Are there multiple counties for this zip code, did you select the right one?
- Does the plan appear on Medicare.gov? (they are the source of truth)
- Are there any filters set that might be hiding some of the plans?
Things to check for MAPD / Part D / MA plans
- Is it a very small regional carrier? There are a handful of those we can't show (Verda, Community Health Choice, etc)
- Is it an I-SNP plan? We don't show those
Things to check for Med Supp plans
- We have about 30 Supp carriers quotable. Are they on this list?
- Are you quoting for someone who will not yet be 65 by the time of their effective date? That might explain it.
- Some carriers are finicky about only appearing if you answer the Med Supp qualifying questions in a specific way, try answer it slightly differently.

The prices in the quoter look wrong

For premiums, copays etc, for MAPD/MA/Part D plans
- Do you have Extra Help set to Yes? That affects drug price & premium.
- How does it compare to the carrier SOB doc? That's the source of truth.
- How does it compare to Medicare.gov? That's the other source of truth.
For drug price discrepancies, see the FAQ question below.

I'm not seeing the expected drug quote

If a drug appears as covered, uncovered, or priced differently than expected:

Compare the result with Medicare.gov to see if there’s a discrepancy.
Check if you selected a similarly named drug – that can change results.
Check the dosage – some carriers cover certain dosages and not others (e.g. Metformin is often covered in the tablet form, but not the solution/liquid form).
Also verify whether the Extra Help toggle is set correctly — switching between “Yes” and “No” affects drug pricing.

I'm not seeing an expected hospital in network

Hospital campuses typically have many search results for their various specialties – if you select the result for a hospital listed as “General Acute Care Hospital”, that will show the proper network status.

Estimated drug cost per month looks wrong

If you're seeing the numbers go from low to high as the months progress:
that's likely because you've got some drug quantities set to "per X months" and the monthly estimates are accurately reflecting that filling schedule.
If the price for a drug seems very high, due to it showing as Not Covered, but you'd expect it to be Covered, then check whether a different form/dosage of that drug is covered. Some plans will cover a drug, but for only certain forms/dosages of that drug (i.e. liquid vs non-liquid).
If the price for a drug seems very high, check that the Pharmacy selected is in network for that plan.

If your client’s drug costs are moving into the catastrophic phase earlier than expected (well before reaching the $2,100 cap) it’s likely they’re in an Enhanced Alternative (EA) plan. In EA plans, the amount that counts toward the Catastrophic Threshold (True Out-of-Pocket, or TROOP) isn’t always the same as what the member actually pays. Per CMS rules, the TROOP amount is the greater of the member’s cost share or 25% of the drug’s retail price. Example: If a drug has a $100 retail price and a $10 copay, the member pays $10, but $25 (25% of $100) counts toward the TROOP. This means the member can reach the catastrophic phase – and see cost-sharing drop to $0 – well before paying the standard $2,100 out of pocket.
If your client’s drug costs are moving into the catastrophic phase earlier than expected (well before reaching the $2,100 cap) it's a rare possibility that you added a drug with a dosage that has a package, then edited it to a dosage that doesn't have a package – after you save that edit, the package value hangs around when it shouldn't, like this. This causes quoting bugs. To fix this issue, edit the drug, then save it.