Medicare star ratings help people compare the quality of health and drug plans. The Centers for Medicare & Medicaid Services (CMS) base the ratings on specific measurements and update them each fall.
Medicare is a health insurance program for people aged 65 years or older and for some younger people with certain disabilities. The program comprises four main parts, part A through D.
Parts C and D are available through private insurance companies and offer additional benefits to Original Medicare, which includes Parts A and B. The Medicare star ratings is a rating system that can provide people with more information to consider when choosing a health plans that include Parts C and D.
Medicare’s star rating refers to a rating system that provides more information to consider when choosing a health or prescription drug plan. It shows a plan’s performance ratings and allows a person to easily compare health plans, to help them make the best healthcare decision for them.
The Centers for Medicare & Medicaid Services (CMS) developed the star ratings system and release updates for the ratings each fall.
The star ratings system is a 5-star scale, with 1 being the lowest score and 5 being the highest. The performance ratings are based on the details of the plan and information from various sources, including healthcare providers and member satisfaction surveys.
The rating system only applies to Medicare Part C, also known as Medicare Advantage, and Medicare Part D, also known as prescription drug plans.
The CMS may provide separate ratings for both Parts C and D, known as a summary rating, as well as an overall ratings, which combines both parts.
Only Medicare Part C plans and Part D plans get star ratings. The star rating system tells a person how well each plan performs. Plans get a rating in several categories with different weightings before the CMS assign them an overall star rating.
For example, the CMS will add new measures to help with 2026 star ratings. This will include weighting for the following measures:
- kidney health evaluation for those with diabetes
- improving or maintaining physical health
- improving or maintaining mental health
Medicare Advantage
The performance of Medicare Advantage plans in 5 categories contributes to their score:
- tests, screenings, and vaccines
- responsiveness and care
- managing chronic conditions
- complaints, problems, and people leaving the plan
- customer service
Plan D
The rating of Part D plans involves 4 categories:
- customer service
- complaints, problems, and people leaving the plan
- member experience
- accurate pricing and patient safety
A person can check a plan’s star rating using this online tool or by calling 1-800-MEDICARE.
According to the CMS, almost half of all Medicare Advantage plans that include prescription drug coverage have an overall rating of 4 stars or higher for 2024.
Special enrollment periods (SEPs) refers to certain circumstances that allow a person to enroll in or make changes to their Medicare plans outside of the usual enrollment periods.
If a plan with a 5-star rating is available, a person can use the 5-star SEP to switch from their current plan. The 5-star SEP runs from December 8 to November 30.
However, it is important for a person to consider the potential changes to their coverage.
For example, if a person switches from an Advantage plan with drug coverage to a 5-star plan without drug coverage, they will lose their prescription drug benefit. They may have to wait until the next open enrollment to get drug coverage and may have to pay a Part D late enrollment penalty.
If a person chooses to switch from an Advantage plan to a 5-star Part D drug prescription plan, they will lose the Medicare Advantage coverage, and Medicare will automatically enroll them in original Medicare (Parts A and B). They can enroll in a Medicare Advantage plan again during open enrollment.
What are star ratings in Medicare?
The star ratings refer to a rating system for healthcare plans that include Medicare Parts C and D. It is a 5-star scale, with 1 being the lowest score and 5 being the highest. People will rate the plan depending on measures such as customer satisfaction and quality of the plan.
Generally, people may consider plans with less than 3 stars as lower-quality and may not be sufficient to meet health needs.
How often are Medicare star ratings released?
The CMS release the final ratings for the Medicare star ratings in October of each year.
What does it mean to be a 5 star Medicare plan?
A 5-star rating is the highest rating possible for a Medicare plan. As such, people can consider any Medicare plan with a 5-star rating as excellent.
What are the CMS star measures?
Typically, the CMS base their ratings for Medicare Part C plans on 5 categories:
- member experience
- customer service
- plan performance
- chronic condition management
- preventative measures to keep members healthy
For Medicare Part D, the CMS usually base it on 4 categories:
- member experience
- customer service
- plan performance
- drug safety and pricing
Medicare uses a five-star rating system to help people compare plans. The ratings are based on customer satisfaction and a review of records.
The system uses five categories to rate Advantage plans and four categories to rate Part D plans. People can find the star ratings for the plans available in their area using the Medicare plan finder online tool.
Medicare has a special five-star rating open enrollment period from December 8 to November 30 each year, during which a person can switch from their Advantage plan to a five-star plan.
