Medicare employs a star rating system that helps beneficiaries assess the quality and performance of Medicare Advantage and Part D prescription drug plans. Ratings span from one to five stars, with five representing the highest level of quality. Familiarizing yourself with these ratings can help you select a stronger plan.
How the Star Rating System Is Structured
Every year, the Centers for Medicare & Medicaid Services (CMS) reviews each Medicare Advantage and Part D plan using dozens of quality indicators. These indicators fall into several categories:
For Medicare Advantage Plans
- Preventive care: Screenings, vaccinations, and wellness exams
- Chronic condition management: How effectively the plan supports members dealing with diabetes, high blood pressure, and other long-term health issues
- Member satisfaction: Survey results reflecting how members rate their plan and healthcare experience
- Complaints: The volume of complaints received and how they were addressed
- Customer service: How well the plan manages calls, appeals, and information requests
For Part D Plans
- Medication safety: Monitoring for dangerous drug interactions and proper medication use
- Member satisfaction: How members rate the plan's drug coverage and services
- Complaints and appeals: How the plan handles issues related to prescriptions
- Customer service: Timeliness and accuracy of plan communications
- Drug pricing: How competitive the plan's medication costs are
What Each Star Rating Means
| Rating | Description | |---|---| | 5 stars | Outstanding performance | | 4 stars | Above average | | 3 stars | Average | | 2 stars | Below average | | 1 star | Poor performance |
Why Star Ratings Are Important
Enhanced Benefits for Top-Rated Plans
Plans rated four stars or higher may receive bonus payments from Medicare, which they frequently use to provide extra member benefits such as lower premiums, reduced cost-sharing, or broader dental and vision coverage.
Special Enrollment Opportunity
Beneficiaries enrolled in a plan rated below three stars may be eligible for a Special Enrollment Period to move to a higher-rated plan.
Five-Star Plan Enrollment
Plans that achieve a perfect five-star rating enjoy a special advantage: beneficiaries can enroll in them at any point during the year, not only during the regular enrollment periods.
Limitations to Keep in Mind
While star ratings are a helpful resource, they do have some drawbacks:
- Ratings represent plan-wide averages and may not mirror your personal experience
- They are calculated using data from the prior year and may not reflect current quality
- A strong overall rating does not guarantee the plan is the ideal match for your specific medications, providers, or healthcare needs
- Newer plans may lack sufficient data to receive a star rating
How to Look Up Star Ratings
- Go to Medicare.gov and use the Plan Finder tool
- Star ratings appear next to each plan's name
- You can filter results by star rating to view only higher-rated plans
- Click on any plan for a detailed breakdown of how it performs in each category
Making Smart Use of Star Ratings
Star ratings should be one element of your plan decision, not the sole factor. Also take into account:
- Whether your preferred doctors and hospitals participate in the plan's network
- Whether your prescriptions appear on the plan's formulary
- Total projected costs including premiums, deductibles, and copays
- The plan's additional benefits beyond standard Medicare coverage
Pairing star ratings with a careful review of plan specifics gives you the best opportunity to find high-quality coverage that fits your needs.