What Are Medicare Star Ratings?
- Every year, Medicare evaluates plans based on a 5-star rating system. Medicare Star Ratings can help you as you compare Medicare Advantage or Medicare Part D plans based on their customer service, health outcomes and other factors.
Quality is important to consumers, and one way to compare Medicare plans is by reviewing Medicare Star Ratings.
Every year, Medicare evaluates plans based on a 5-star rating system. Each fall, the Centers for Medicare & Medicaid Services (CMS) rates every Medicare Advantage and Medicare Part D plan according to various criteria and assigns each plan a rating, with 5 stars being the best and plans with 4 or more stars considered top-rated plans.
- 5 Stars: Excellent
- 4 Stars: Above Average
- 3 Stars: Average
- 2 Stars: Below Average
- 1 Star: Poor
Medicare Star Ratings are based on the plan’s current year performance and are assigned to the plan for the following year. Medicare Star Ratings are released before the Annual Enrollment Period (AEP, also called the Fall Medicare Open Enrollment Period), which takes place from October 15 to December 7 every year.
During fall open enrollment, Medicare beneficiaries may enroll in, change or drop Medicare Advantage and Medicare Part D plans. The star ratings are an integral part of this enrollment season, as many consumers take a plan’s star rating into account when making their coverage selections.
There's also a Special Enrollment Period (SEP) called the Medicare 5 Star Special Enrollment Period. Anyone who is enrolled in a plan rated lower than 5 stars may switch to a 5-star plan at any time between December 8 and the following November 30 if a 5-star plan is available where they live.
How Are Medicare Plans Rated?
Medicare Advantage plans without prescription drug coverage are rated on the following 5 categories:
- Staying healthy: Access to exams, screenings, vaccines and other preventive care measures
- Management of chronic conditions: Coordination of care and the frequency which members received services for long-term health conditions
- Member experience: Members’ overall satisfaction with the plan and its responsiveness to care needs
- Member complaints: The frequency of member complaints and the plan’s retention rate, along with how many members encountered problems receiving services and how the plan’s performance changed from the previous year
- Customer service: Quality of call center services including TTY and interpreter services, along with processing appeals and new enrollments
Medicare Advantage plans with prescription drug coverage and Medicare Part D prescription drug plans are rated on member experience, member complaints, customer service and drug safety and drug pricing accuracy, which gauges how safely patients are prescribed drugs under the plan and measures the accuracy and competitiveness of the plan’s drug pricing information.
Each Medicare Advantage and Part D plan is assigned an overall star rating and is also assigned a star rating for each individual category listed above.
Why Are Medicare Star Ratings Important?
Medicare incentivizes plan carriers to provide high-quality care by offering bonuses to plans and insurance companies that demonstrate continually high star ratings. When choosing the best Medicare Advantage plan available where you live, the Medicare Star Rating system can be helpful for your comparisons.
Medicare plans that consistently earn low star ratings may be sanctioned by Medicare or even removed from the marketplace entirely.
According to the Kaiser Family Foundation, 86% of Medicare Advantage plan beneficiaries were enrolled in a plan rated at least 4 stars in 2022.
When it comes to Medicare Part D plans, around 94% of beneficiaries were enrolled in a plan rated 3.5 stars or better in 2022, and the average star rating for a Part D plan in 2022 was 3.7.