AA

Medicare Star Ratings

Medicare stars is a rating system by The Centers for Medicare & Medicaid Services (CMS). The system rates Medicare Advantage (MA) and Prescription Drug (PDPs or Part D) plans on a 5 star scale - 1 being the lowest and 5 being the highest. Measurements focus on health plan quality based on measurements of customer satisfaction and quality of care the plan delivers.

The goal of the ratings is to improve the quality of care and general health status for Medicare beneficiaries and support the efforts of CMS to improve the level of accountability for the care provided by physicians, hospitals, and other providers.

Finding a Plan’s Star Rating

Star ratings for current Medicare Advantage or Prescription Drug Part D plan by using the Medicare plan finder or by taking our Medicare Questionnaire.

Star Ratings Review

Each year plans star ratings are reviewed and updated by CMS, with the final quality ratings released in October. If plans are new to the marketplace, they will not have ratings.

Medicare Advantage plans are given an overall rating based on 5 categories

  • Member experience (with the health plan) - Member ratings of the plan

  • Customer service - How well the plan handles member appeals

  • Plan performance – Focuses on member complaints and changes in the plan’s performance. Includes how often Medicare found problems with the plan, how often members had problems with the plan, and how much the plan's performance has improved over time.

  • Chronic conditions - How often members with certain conditions got recommended tests and treatments to help manage their condition.

  • Staying healthy – If members got various screening tests, vaccines, and other check-ups to help them stay healthy.

Medicare Part D plans are given an overall rating based on 4 categories

  • Member experience (with the drug plan) - Member ratings of the plan

  • Customer service - How well the plan handles member appeals

  • Plan performance – Focuses on member complaints and changes in the plan’s performance. Includes how often Medicare found problems with the plan, how often people had problems with the plan, and how much the plan's performance has improved (if at all) over time.

  • Drug safety and pricing - How accurate the plan’s pricing information is and how often people with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.

The Importance of Star Rating on Health

Star ratings provide additional points of comparison long with costs and coverage when choosing a Medicare plan. If enrolled in a Medicare plan that is less than 3 stars it’s considered poor quality and is likely not providing you with the most optimal health care options for you.

Enrolling in a 5-star plan

Enrollment in a Medicare Advantage (MA) or Medicare Prescription Drug (Part D) star rated plan can occur any time of the year using the enrollment periods below.

  1. Initial Enrollment Period (new to Medicare).

  2. Open Enrollment Period (Oct. 15 – Dec. 7 annually; for those already enrolled and switching plans).

  3. During a Special Enrollment Period (SEP).

Special Enrollment Period to enroll in a 5-star plan

Switching to a plan that has 5 stars for its overall star rating can occur December 8 to November 30, but it limited to one usage during this timeframe. Additionally, switching to a 5-star Medicare Prescription Drug Plan can only happen if one is available in the local area.

Special Enrollment Period to dis-enroll from lower-rated plans

People who are enrolled in a low-performing plan, a plan that has received a rating of fewer than 3 stars for three straight years from CMS, get a one-time SEP from January 1 to December 31 to enroll in a plan that is rated 3-stars or better or a plan with no rating (since there are some plans that are too to rate).

For both SEPs prescription drug coverage may be lost if moving from a Medicare Advantage Plan that has drug coverage to a 5-star Medicare Advantage Plan that doesn’t. You may have to wait until the next Open Enrollment Period to get drug coverage and end up with a late enrollment penalty.

Related Content

Understand Medicare Enrollment Periods
There are certain times when Medicare enrollment can occur. For some, enrollment is automatic but for others, they will need to apply.
Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period provides additional opportunities to change Medicare Advantage plans outside the Annual Election Period.
Medicare Special Enrollment Periods (SEP)
There are Special Enrollment Periods (SEPs) that apply when eligible for delayed enrollment in Medicare Parts A, B, C & D. Only for certain circumstances.

Age Well Planner is an educational website created by nonprofit the National Council on Aging (NCOA). We provide information, resources, and referrals on topics such as: Benefits, Income, and Medicare.

Connect With Us