How to read a Medicare Advantage Summary of Benefits
The Summary of Benefits is the short, standardized document that lays out what a plan costs and covers. Here's how to read one without getting lost, and which lines matter most.
What it is
The Summary of Benefits is a standardized summary CMS requires every plan to publish. It is not marketing; it's the plan's own filed benefits in a set format, which makes plans comparable. It is shorter than the Evidence of Coverage, the full legal document that governs when the two disagree.
Read these lines first
Start with the monthly premium, the deductibles (medical and drug), and the MOOP — your yearly ceiling. Then the cost sharing for the services you use most: primary care, specialists, urgent care, the emergency room, and an inpatient hospital stay (often billed per day for the first several days). Those few lines decide most of what a plan will cost you.
Then the drugs and the extras
Check the Part D section for the tiers and whether your drugs need prior authorization. Then the supplemental benefits — dental, vision, hearing, over-the-counter — reading the annual maximums and whether a benefit is comprehensive or preventive only, not just that it exists.
What it doesn't tell you
A Summary of Benefits does not list which doctors or hospitals are in network, or which pharmacies are preferred, or the fine print on how a benefit works. For those you need the provider directory, the formulary, and the Evidence of Coverage. Confirm anything that would change your decision.
Find any plan's SoB here
Every plan page on this site links that plan's Summary of Benefits from the carrier's own website. Open a county, pick plans that fit, and read their SoBs before deciding.