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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 the fall Medicare open enrollment period. While the U.S. Centers for Medicare & Medicaid Services (CMS) releases new star ratings in mid- to late September, they do not appear on the Medicare.gov website until early to mid-October.
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 & 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.
The 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.
Note
Centene, Humana, and UnitedHealthcare have each filed lawsuits against the Centers for Medicare and Medicaid Services, claiming it unfairly downgraded the star ratings of their Medicare Advantage plans. All three say CMS lowered their star ratings based on a handful of “secret shopper” calls to company call centers; Centene and Humana say their downgrades were each based on a single call. Humana also claims CMS changed the thresholds used to calculate star ratings in a way that lowered its ratings and did not allow Humana to validate the accuracy of those changes. The lawsuits ask CMS to recalculate their star ratings.
How Do Medicare Star Ratings Work?
Every fall, the CMS 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 with Part D drug coverage, star ratings are based on up to 40 unique quality and performance measures. Medicare Advantage plans without Part D coverage and standalone Medicare Part D-only plans are rated on up to 30 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.
Important
Medicare star ratings are not the same as the 5-star quality rating system that the CMS uses to evaluate nursing home facilities.
Types of Medicare Star Ratings
Overall Medicare Star Ratings for Plans
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.
- 5 Stars: Excellent
- 4 Stars: Above average
- 3 Stars: Average
- 2 Stars: Below average
- 1 Star: Poor
Plans that receive 3 or fewer stars for three 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 Dec. 8 and Nov. 30 the following year.
Note
According to the U.S. Centers for Medicare & Medicaid Services, 74% of people enrolled in Medicare Advantage plans that include Part D prescription drug coverage had plans with 4-star or higher ratings for 2024.
Ratings for Subcategories and Individual Criteria
Star ratings are provided to the plan overall, each subcategory, 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.
Note
Nonprofit healthcare organizations tend to earn higher ratings than for-profit organizations, according to the CMS.
Pros and Cons 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 rating 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, coinsurance, and copays.
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 can 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 third line beneath the provider’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 criteria that’s measured. 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.”
Frequently Asked Questions (FAQs)
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 & Medicaid Services (CMS) updates Medicare star ratings each year. The new ratings generally come out in September ahead of the annual Medicare open enrollment period. However, new ratings do not appear on the Medicare.gov website until early to mid-October.
What Are the Benefits of a 5-Star Medicare Plan?
Generally, 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
If you’re planning to enroll in Medicare Advantage for the first time or switch to a new Medicare Advantage, consider using Medicare star ratings to help in your 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 available to you. 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.