Medicare Star Ratings

Medicare star ratings are designed to help you compare Medicare Advantage plans based on factors such as customer experience and preventive services offered. Learn how to use them to compare plans.

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What Are Medicare Star Ratings?

Medicare star ratings help you compare the quality of Medicare Advantage plans at enrollment time. They range from 1 to 5 stars (1 is the lowest). Medicare reviews plan performance once a year on factors such as the number of annual screenings and preventive services offered, how long it takes to get an appointment, and complaint levels. New star ratings come out each fall ahead of open enrollment.

Medicare Advantage plans (private insurance plans that replace the benefits offered under Medicare Parts A and B) as well as Medicare Part D prescription drug plans receive star ratings.

KEY TAKEAWAYS

  • Medicare Advantage plans combine Medicare Parts A and B into a single coverage option.
  • The U.S. Centers for Medicare and Medicaid Services (CMS) issues Medicare star ratings to help consumers compare Medicare Advantage and Medicare Part D plans ahead of the annual open enrollment period.
  • Plans earn 1 to 5 stars based on factors such as member experience, services offered, and drug pricing accuracy.
  • Medicare Advantage plans with higher star ratings may offer more features and benefits than lower-rated plans.

What Are Medicare Star Ratings?

The U.S. Centers for Medicare and Medicaid Services (CMS) developed Medicare star ratings to help older adults evaluate options when planning to enroll in a Medicare Advantage plan for the first time or switch to a new plan,

The Medicare star ratings system operates on a scale from 1 to 5. A 1-star rating represents the lowest score, while a 5-star rating represents the highest. The ratings are released annually ahead of the fall Medicare open enrollment period.

Medicare star ratings are not the same as the 5-star quality rating system that the U.S. Centers for Medicare and Medicaid Services uses to evaluate nursing home facilities.

How Do Medicare Star Ratings Work?

Every fall, the U.S. Centers for Medicare and Medicaid Services releases Medicare star ratings ahead of open enrollment, which is Oct. 15 to Dec. 7 each year, or Jan. 1 to March 31 if you already have a Medicare Advantage plan.

For Medicare Advantage plans plans with Part D drug coverage, star ratings are based on up to 38 unique quality and performance measures. Medicare Advantage plans without Part D coverage and standalone Medicare Part D-only plans are rated on fewer measures.

The measures are grouped into these categories:

  • Staying healthy: Annual breast cancer and colorectal screenings, annual flu vaccines, and other preventive offerings and screenings, for example.
  • Managing chronic (long term) conditions: Including diabetes care and blood sugar control, osteoporosis management, and other conditions.
  • Member complaints and changes in health plan performance: Including complaints and people choosing to leave the plan.
  • Member experience with health plan: Including speed of getting appointments with specialists, getting care, and customer satisfaction.
  • Health plan customer service: Timely and fair appeals decisions, availability of TTY and foreign language service.

Part D plans are rated on customer service, member complaints and experience, problems getting services and leaving the plan, and drug pricing and patient safety.

The CMS conducts an annual review of star rating measures by assessing the data's reliability, new clinical recommendations, and stakeholder feedback. Therefore, the methodology can change from year to year.

Note

According to the U.S. Centers for Medicare and Medicaid Services, 72% of people enrolled in Medicare Advantage plans that include Part D prescription drug coverage had plans with 4-star or higher ratings for 2023.

Types of Medicare Star Ratings

Medicare Star Ratings: Scale

While new Medicare Advantage plans may not have enough information to be rated, most plans are rated. Ratings range from 1 to 5. Half-stars are also awarded, such as 4 1/2 stars.

  • The 5 Stars: Excellent
  • The 4 Stars: Above average
  • The 3 Stars: Average
  • The 2 Stars: Below average
  • The 1 Star: Poor

Plans that receive 3 or fewer stars for 3 consecutive years are considered "consistent low performers." If you're enrolled in a low-performing plan, you'll receive a notice in the mail about it. You can switch plans at the annual open enrollment, or may have access to special enrollment periods. In some states such as Oregon, you can leave a consistently low-performing plan at any time.

Medicare Advantage Plans earning a 5-star rating qualify for the 5-star special enrollment period. This special enrollment period allows you to switch to the 5-star plan between December 8 and November 30 the following year.

Medicare Star Ratings: Application

Star ratings are provided to the plan overall, each sub-category, and also for each measure.

For example, a plan could have a 4 1/2 star rating overall. But "Member Experience with Health Plan" might only have 3 stars.

Then, Medicare shoppers could review star ratings for each specific subcategory measure:

  • Ease of getting needed care and seeing specialist
  • Getting appointments and care quickly
  • Health plan provides information or help when members need it
  • Members' rating of health care quality
  • Members' rating of health plan
  • Coordination of members' health care services

A plan might excel at one Medicare star rating measure, and fall short in another. For example, the "coordination of members' health care services" could earn 4 stars, while "ease of getting needed care and seeing a specialist" could earn 2 stars.

Non-profit healthcare organizations tend to earn higher ratings than for-profit organizations, according to the CMS.

Advantages and Disadvantages of Medicare Star Ratings

Medicare star ratings can be helpful when gauging overall customer satisfaction with a specific plan and the range of coverage, services, and support provided. The ratings can help you determine how well a plan can help you manage a chronic disease, or what it offers to keep you healthy.

The ratings system can offer special enrollment periods you can take advantage of, as with a 5-star plan.

But the rating system can't assess every aspect of every plan. So consider your individual needs and preferred healthcare providers when reviewing plans—for example, if you have a condition that isn't addressed by the current star rating system.

Notably, the Medicare star ratings do not take into account the cost of the plan itself, including premiums, co-insurance, and co-pays.

Example of Using Medicare Star Ratings

Let's say a woman named Lucy logs in to her Medicare account or searches for plans by ZIP code on the Medicare website. She is shown a list of available plans in her area in order of star rating. The highest-rated plans will be at the top. She can also filter the results by star ratings so that, for instance, she could view only 5-star plans.

At this point, she can review information for each plan, including monthly premiums, drug coverage, and plan benefits. The star rating is displayed in the second line beneath the plan's name. Clicking on the words "star rating" will produce a pop-up that includes the linked phrase "Learn more about Star Ratings."

Clicking on that link will produce in-depth star ratings for the plan on each measure. For example, if Lucy has osteoporosis, she can see how the plan manages osteoporosis. Even an otherwise-appealing 4 1/2-star plan could only have 2 stars in osteoporosis management. Or it could have a lower score in "getting appointments and care quickly."

What are Medicare Star Ratings?

Medicare star ratings are ratings that measure various features of Medicare Advantage plans, including the quality of care provided, the range of benefits, and customer support. Medicare recipients can use Medicare star ratings as a guide when determining which Medicare Advantage plan or Part D plan to join.

When Do Medicare Star Ratings Come Out?

The U.S. Centers for Medicare and Medicaid Services (CMS) updates Medicare star ratings each year. The new ratings generally come out in the fall ahead of the annual open enrollment period for Medicare.

What are the Benefits of a 5-Star Medicare Plan?

Generally speaking, a higher Medicare star rating indicates a higher level of satisfaction with the plan among people enrolled in it. Choosing a 5-star plan may also give you enhanced benefits if the plan includes a wider range of features or services compared to a 1-star plan. Star ratings do not, however, indicate what you’ll pay for a Medicare Advantage or Medicare Part D plan.

The Bottom Line

Older adults planning to enroll in Medicare Advantage or switch to a new Medicare Advantage should consider using Medicare star ratings to help in their decision-making.

Choosing the right Medicare Advantage or Medicare Part D plan matters, as you don’t want to get stuck with a plan that doesn’t fit your needs or budget. Review Medicare star ratings ahead of the open enrollment period to help narrow down the list of plans you’re interested in. You can then research the details of each plan on your shortlist to help you determine the one that's the best choice for you.

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