The 90505 Example
What one Self-Audit revealed about one zip code.
Four prescriptions. Two doctors. One zip code. Four months in Arizona. A budget line Margaret named before the plans entered the room.
This is how 74 Medicare Advantage plans became two finalists — and how Original Medicare + Medigap Plan G + a stand-alone Part D plan was tested against the same requirements.
The plans did not define the decision. Margaret's life did.
The person before the plans
Meet Margaret.
Margaret is 68 and lives in Torrance, California. She spends November through February in Scottsdale, Arizona. That has been part of her life for ten years, and she is not giving it up.
She takes four prescriptions: one formulary-sensitive brand-name anticoagulant and three generics. She sees a cardiologist in Torrance and a family-medicine doctor she trusts. She may need an orthopedist for her knee.
Her cost lines are clear. $150 a month is comfortable. A $400 month creates strain.
Margaret is not naive. She is not careless. She is making her first Medicare decision with a real life that has to fit inside it.
Margaret is an illustrative composite. Her cascade counts, plan data, and California figures are based on a Medicare.gov Plan Finder pull for ZIP code 90505 and published California Medicare Supplement rate data. Her name and identifying details are anonymized.
Margaret was not imagining the overwhelm.
In the months before her Medicare decision, Margaret encountered television ads, mailer campaigns, broker calls, webinar invitations, and government documents. Each source presented itself as helpful. None of them started with her situation.
KFF found that Medicare Advantage plans aired more than 550,000 television ads in 2022 alone. CCDH documented that 27% of Medicare Advantage airings showed a Medicare card or similar image, while 16% promoted a privately run number as a "Medicare" hotline. That helps explain why commercial messages may feel official rather than commercial.
- · benefits that sounded important but may not have mattered to her;
- · plan names that looked different but came from a concentrated market;
- · doctor-network claims she still had to verify;
- · low-premium language without the full annual cost;
- · advice shaped by what a presenter or agent could offer;
- · uncertainty about what had not been shown.
Her problem was not finding Medicare information.
It was determining which information survived contact with her life.
Sources: KFF television-ad analysis; CCDH digital-ad investigation. Publication dates and measurements pending final verification before publication.
"I have all these plans, but I do not know what should eliminate one."
"Let's begin with what your coverage must protect. Which parts of your life would make a plan unworkable even if the premium looked attractive?"
Why this mattered: Fern helped turn general concern into usable requirements.
plans on the shelf.
In ZIP code 90505, Margaret had 74 Medicare Advantage plans available for the 2026 plan year after Special Needs Plans were excluded.
That number is context, not a warning.
The question was not whether 74 plans were too many. The question was which of the 74 could satisfy the requirements she had already named.
74 plans on the shelf.
None of them knew Margaret yet.
Her calendar cut 66 plans.
Margaret spends four months each year in Arizona. A plan built around one local service area could leave her with limited or more expensive access to routine care while she is away.
She filtered for the out-of-area flexibility her calendar required.
One requirement eliminated 66 of the 74 plans — about 89% of the field — before deeper review began.
Her life cut 66 plans.
Nobody argued with her calendar.
Data, date, and limitation ▾
Source: Medicare.gov Plan Finder pull for ZIP code 90505, 2026 plan year, Special Needs Plans excluded. The travel screen reflects plan service-area and out-of-area access rules, not a guarantee of coverage in Arizona. Counts and rules pending final source verification before publication.
Her medications cut two more.
Of the 8 plans that survived the travel filter, 2 did not cover her brand-name anticoagulant at an acceptable tier. They were eliminated.
Her cardiologist cut the list to three.
Three of the remaining 6 plans did not include her Torrance cardiologist in-network. Each required a phone call to confirm. Three plans were eliminated.
Her budget left two finalists.
One of the remaining 3 plans had a worst-case out-of-pocket exposure that crossed Margaret's $400 strain line. It was eliminated.
74 became two.
Seventy-two plans disqualified themselves because they did not fit Margaret's life.
Two finalists — and the other Medicare route.
The two MA-PD finalists survived Margaret's Self-Audit Worksheet. But the list also had to be applied to the other Medicare structure: Original Medicare + Medigap Plan G + a stand-alone Part D plan.
- ✓ $45 monthly premium in addition to Part B
- ✓ $0 health deductible
- ✓ $0 drug deductible
- ✓ in-network out-of-pocket maximum around $4,200
- ✓ cardiologist requirement passed
- ✓ prescription requirement passed
No Medicare star rating was yet available.
- • $0 monthly premium in addition to Part B
- • $500 health deductible
- • $615 drug deductible
- • in-network out-of-pocket maximum around $6,350
- ✓ cardiologist requirement passed
- ✓ prescription requirement passed
The front-loaded exposure crossed Margaret's strain line.
- • no MA network restriction
- • Medicare-accepting doctors usable nationally
- • separate Part D comparison required
- • fixed Medigap premium
- • lower variability in approved medical costs
- • Medigap timing and future underwriting considerations matter
Higher fixed monthly cost in exchange for greater predictability.
One route bent Margaret's monthly-cost line. The others bent her surprise-cost line. Which line was a requirement — and which was a preference — was the decision.
Costs, networks, formularies, premiums, rights, and rules vary by date, plan, state, and individual circumstances.
Most people never see the 74.
They see the plans available through the person or organization presenting them. That is not automatically deceit. It is often contracting. An agent or broker may only be able to show plans from the carriers they represent. A webinar may be educational while still covering only part of the market or only one Medicare structure.
The number of plans shown is not the same as the range of choices considered.
"How many carriers do you represent — and which of the plans on my list can you show me?"
"Can you show me both structures — Medicare Advantage and Medigap — or only one?"
"If the plan that fits my list best is not one you sell, will you tell me?"
A good agent becomes more useful when the client brings a Self-Audit Worksheet. The conversation shifts from reacting to the shelf toward verifying what fits.
The menu arrives pre-shrunk. The list shows what was cut before you sat down.
- • begins with the presenter's menu;
- • reacts to the plans shown;
- • compares promoted benefits;
- • may not see omitted structures or carriers;
- • has difficulty knowing whether the recommendation is complete.
- ✓ begins with her non-negotiables;
- ✓ asks what the presenter represents;
- ✓ tests the shown plans against her criteria;
- ✓ identifies options not on the shelf;
- ✓ knows which questions require independent verification.
What might have happened without the list ▾
Had Margaret begun inside an agent's available shelf, she might have received a useful recommendation from the plans that agent represented.
But she may never have known that 74 MA plans existed in her zip, that a smaller regional PPO survived her requirements, whether Original Medicare + Medigap Plan G + a stand-alone Part D plan had been considered on equal terms, which carriers or products were outside the agent's contracts, or which options had disappeared before her doctors, prescriptions, travel, and budget were applied.
Without the list, Margaret might have chosen the best plan she was shown. With the list, she could ask whether the best-fitting option had been shown at all.
Margaret chose one of the two MA-PD finalists.
She chose the regional PPO.
The choice fit Margaret's situation at that time. It is not a recommendation for anyone else.
- · the $0 drug deductible mattered more than the missing star-rating history;
- · she preferred a known monthly premium to a first-month deductible that crossed her strain line;
- · her doctors and prescriptions fit after verification;
- · she considered Original Medicare + Medigap Plan G + a stand-alone Part D plan seriously;
- · the additional fixed monthly cost felt larger than she wanted to accept while her health was stable;
- · she understood that changing to Medigap later might involve health questions.
She did not choose the cheapest plan. She did not choose the highest-rated plan. She did not choose the most predictable route.
She chose the option that best matched the requirements she had written before the plans got a vote.
The framework, sequence, worksheets, and decision criteria.
Clarify, question, organize, prepare verification, and preserve continuity.
What mattered, which tradeoffs were acceptable, and which option fit.
Margaret finished with more than a plan choice.
What coverage had to protect.
Which doctors, prescriptions, costs, route rules, and plan facts were checked — and where.
What Margaret chose, why she chose it, which tradeoffs she accepted, and what remained uncertain.
What should be checked again during the next annual review.
The decision was not only made.
The reasoning was preserved.
What this example cannot do for you.
This page shows how one Self-Audit Worksheet was applied to one person, one zip code, and one plan year. It cannot:
- — enroll you;
- — compare every plan for your situation;
- — pull your claims history;
- — price your prescriptions at your specific pharmacy;
- — tell you which Medicare route to choose.
The market changes underneath the decision.
Networks renew. Formularies change. Premiums move. Plans enter and leave markets. Doctors change contracts. Prescriptions change.
Margaret's 2026 decision may still be reasonable in 2027 — or it may not. The value of the Self-Audit Worksheet, verification record, and Decision Memo is that she does not have to reconstruct the decision from scratch.
The record gives Margaret a place to begin again.
One decision. Six connected parts.
Margaret made the choice.
The Clearing made the process visible, ordered, and reusable.
Your life should do the filtering.
The Self-Audit helps identify the doctors, prescriptions, timing, budget, travel, preferences, and risks that should shape your Medicare decision before anyone begins showing you plans.
The Self-Audit is free and takes about 10 minutes to begin.