What Are Medicare Star Ratings?

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  • 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:

  1. Staying healthy: Access to exams, screenings, vaccines and other preventive care measures

  2. Management of chronic conditions: Coordination of care and the frequency which members received services for long-term health conditions

  3. Member experience: Members’ overall satisfaction with the plan and its responsiveness to care needs

  4. 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

  5. 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. 

5-Star Medicare Advantage Plans 2021
Contract Contract Name Parent Organization Service Area1 Special Needs Plan?
H0332

KS Plan Administrators, LLC

Kelsey-Seybold Medical
Group, PLLC

13 counties in TX

No

H0524

Kaiser Foundation HP, Inc.

Kaiser Foundation Health Plan, Inc.

32 counties in CA

Yes

H0630 

Kaiser Foundation HP of CO

Kaiser Foundation Health Plan,
Inc.

14 counties in CO

Yes

H0710

Sierra Health and Life Insurance
Company, Inc.

UnitedHealth Group, Inc

Most of the U.S.

Yes

H1019

CarePlus Health Plans, Inc.

Humana Inc

18 counties in FL

Yes

H1170 

Kaiser Foundation HP of GA, Inc.

Kaiser Foundation Health Plan,
Inc.

12 counties in GA

Yes

H1230 

Kaiser Foundation HP, Inc.

Kaiser Foundation Health Plan,
Inc.

3 counties in HI

Yes

H1537

Care Improvement Plus South Central
Insurance Co.

UnitedHealth Group, Inc

1 county in NY

No

H2172

Kaiser Foundation Health Plan of the Mid-Atlantic

Kaiser Foundation Health Plan,
Inc

1 county in DC, 11 counties in
MD, 12 counties in VA

No

H2226 

United Healthcare Insurance Co.

UnitedHealth Group, Inc

10 counties in MA

Yes

H2256

Tufts Associated Health Maintenance
Organization

Tufts Health Plan, Inc

10 counties in MA

Yes

H2422

HealthPartners, Inc.

HealthPartners, Inc.

12 counties in MN

Yes

H5042

CDPHP Universal Benefits, Inc.

Capital District Physicians'
Health Plan, Inc

23 counties in NY

No

H5262 

Quartz Health Plan Corporation

University of Wisconsin
Hospitals and Clincs Autho

5 counties in IA, 5 counties in
IL, 27 counties in WI

No

H5410

Healthspring of Florida, Inc.

CIGNA

20 counties in FL

Yes

H5431

Healthsun Health Plans, Inc.

Anthem Inc

3 counties in FL

Yes

H5526

HealthNow New York Inc.

HealthNow New York Inc.

18 counties in NY

No

H5591

Martin’s Point Generations Advantage,
Inc.

Martin's Point Health Care, Inc

16 counties in ME, 10 counties
in NH

Yes

H5652

Serra Health and Life Insurance
Company, Inc.

UnitedHealth Group, Inc

1 county in CO, 1 county in
FL, 1 county in KS, 2 counties
in MA, 3 counties in MD, 1
county in MI, 1 county in NC, 3
counties in NJ, 2 counties in
PA, 2 counties in TX, 2
counties in VA

Yes

H9003 

Kaiser Foundation HP of the NW

Kaiser Foundation Health Plan,
Inc

10 counties in OR, 3 counties in WA

No

H9834 

Quartz Health Plan MN Corporation

University of Wisconsin
Hospitals and Clincs Autho

4 counties in MN

No

According to the CMS, 77% of Medicare Advantage plan beneficiaries are enrolled in a plan rated at least 4 stars in 2021. The average star rating for such plans is 4.06, and nearly half of all plans are rated 4 stars or higher. 

When it comes to Medicare Part D plans, around 98% of beneficiaries are enrolled in a plan rated 3.5 stars or better in 2021, and the average star rating for a Part D plan in 2021 is 3.58. 

  1. Non-employer group health plan (EGHP) service areas. Data taken from CMS. Fact Sheet – 2021 Part C and D Star Ratings. Table 3: MA-PD Contracts Receiving the 2021 High Performing Indicator. https://www.cms.gov/files/document/2021starratingsfactsheet-10-13-2020.pdf.

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