Medicare Star Ratings Guide | Choose Quality Plans
Learn how Medicare Star Ratings work and use them to identify high-quality Medicare Advantage and prescription drug plans.
What Are Medicare Star Ratings?
Medicare Star Ratings are a quality rating system created by the Centers for Medicare & Medicaid Services (CMS) to help beneficiaries compare Medicare Advantage and Part D prescription drug plans.
Rating Scale
Updated Annually
- Released each October
- Based on previous year's performance
- Affects plan enrollment and bonuses
- Available on Medicare.gov
What Star Ratings Measure
Medicare Advantage Plans
Star ratings for Medicare Advantage plans include both health and drug services:
- Quality of care and customer service
- Member experience and complaints
- Health plan administration
- Drug pricing and patient safety
- Drug plan customer service
Part D Drug Plans
Stand-alone Part D plans are rated on drug-related measures:
- Drug pricing and patient safety
- Customer service
- Member complaints and changes
- Drug plan administration
- Pharmacy network performance
Key Rating Categories
Quality of Care (40% weight)
- Preventive care screenings
- Managing chronic conditions
- Medication adherence
- Health outcomes
- Care coordination
- Patient safety
Member Experience (25% weight)
- Customer service ratings
- Doctor communication
- Getting needed care
- Care coordination
- Plan administration
- Shared decision making
Plan Administration (15% weight)
How well the plan handles:
- Appeals and grievances
- Pharmacy networks
- Provider networks
- Accurate marketing materials
How to Use Star Ratings
✅ Do This
- Look for 4 or 5-star plans when possible
- Compare ratings within your area
- Check individual measure scores
- Consider ratings alongside costs and coverage
- Look at rating trends over time
- Read member reviews and experiences
❌ Don't Do This
- Choose based solely on star ratings
- Ignore your specific health needs
- Overlook network and formulary
- Assume higher stars mean lower costs
- Rely on outdated rating information
- Ignore plans with 3+ stars entirely
Special Star Rating Benefits
5-Star Special Enrollment Period
If you're enrolled in a Medicare Advantage or Part D plan, you can switch to a 5-star plan at any time during the year.
Eligibility:
- Must live in a 5-star plan's service area
- Can only use this once per year
- Available December through November
Benefits:
- Switch outside Open Enrollment
- No waiting period
- Coverage starts the next month
Understanding Rating Limitations
⚠️ Important Considerations
Geographic Variations: The same plan may perform differently in different regions due to local provider networks and member populations.
Lag Time: Ratings reflect past performance, not current quality. Recent plan changes may not be captured in the latest ratings.
Sample Size: Plans with very few members may have ratings that don't reliably predict your experience.
Individual Needs: A lower-rated plan might better meet your specific needs if it covers your doctors, medications, or preferred hospitals.
Where to Find Star Ratings
Medicare.gov
Official Medicare Plan Finder with comprehensive ratings and comparisons
Plan Materials
Annual notices, enrollment guides, and marketing materials
Insurance Agents
Licensed agents can explain ratings and help you compare options
Star Rating Trends to Watch
Improving Plans
Plans that have consistently improved their ratings over 2-3 years may indicate strong management and commitment to quality.
Declining Plans
Plans with falling ratings may face challenges with networks, customer service, or care quality.
New Plans
Plans without ratings (marked as "Not Rated") lack performance history but may offer competitive benefits.
Get Help Understanding Star Ratings
Star ratings are just one factor in choosing the right Medicare plan. Our licensed agents can help you interpret ratings and find plans that best meet your needs and budget.