Trying to pick a Medicare plan may seem overwhelming, with all the many things to consider and choose. The Medicare Star Ratings system is one important tool that makes it easier to compare plans which you can find in the Medicare Plan Finder. Ratings are available for Medicare Advantage plans (Medicare Part C) with and without drug coverage and for standalone Medicare Part D plans for prescription drug coverage.
What is the Best Medicare Star Rating?
Medicare gives each plan one to five stars
- Five stars is excellent.
- Four stars is above average.
- Three stars is average.
- Two stars is below average.
- One star is poor.
What Do the Medicare Star Ratings Measure?
Medicare measures up to 40 factors when evaluating Medicare Advantage plans with drug coverage, 28 factors for Medicare Advantage plans without drug coverage, and 12 factors for standalone Part D prescription drug plans.
These factors are organized into five categories for Medicare Advantage plans:
- Staying healthy: screenings, tests, and vaccines.
- Managing chronic (long-term) conditions.
- Members’ experience with the health plan.
- Complaints from members and performance changes.
- Customer service.
The categories for prescription drug plans are:
- Customer service.
- Member complaints and performance changes.
- Members’ experience with the drug plan.
- Drug safety and accuracy of drug pricing.
How Current Are the Medicare Star Ratings?
The ratings are updated annually. Medicare releases new ratings every year in October before the Fall Open Enrollment Period begins.
How Many Medicare Advantage Plans Have High Star Ratings?
According to the Centers for Medicare & Medicaid Services (CMS), in 2022, about 68% of the Medicare Advantage plans with drug coverage that are offered have overall star ratings of four or higher.
Special Enrollment Period for 5-Star Medicare Advantage Plans
Medicare provides a special enrollment period when one can switch from their current Medicare plan to the 5-star plan. The special enrollment period extends almost the whole year – from December 8 to November 30 – but may only be used once. The customer must be living in the appropriate area to be eligible to switch to a specific 5-star plan. Remember, plans are tied to location. One could find an excellent 5-star plan but be ineligible for coverage depending on their circumstances.
Be careful switching from a plan that includes drug coverage to one that doesn’t. Medicare has special rules for that, and switching may mean risking a Part D late-enrollment penalty.
Where Can I Find the Medicare Star Reviews?
The Medicare Star Ratings system doesn’t provide narrative reviews for plans. However, if you would like more information beyond just a plan’s overall star rating, you can get a detailed ratings breakdown using the Medicare Plan Finder:
- Log into the Medicare Plan Finder, or select “Continue without logging in.”
- Answer the questions on the next two pages.
- You will see a list of plans and their overall star ratings.
- Click on the “Star Rating” link that is underneath the name of the plan you are interested in (to the left of the stars).
- A pop-up box will appear. Click on “Learn more about Star Ratings.”
- Click on the “+” where it says, “Health plan star rating.”
This will give you individual star ratings for each of the five categories that the rating system covers. You can get even more detail by clicking on the “+” sign next to each category. For example, when you click on the “+” for the category “Staying healthy: screenings, tests, & vaccines,” you will see separate star ratings for breast cancer screening, colorectal cancer screening, yearly flu vaccine, and monitoring physical activity.
If there are specific aspects of your health care that are especially important to you, drilling down deeper into the ratings is one way to find out if a plan may be a good fit for your needs.
Other Things to Consider
Medicare Star Ratings provide an important tool for comparing and evaluating plans. The star ratings are not enough by themselves, though, for you to select the Medicare Advantage or Part D plan that will best meet your needs. You should also consider:
Total costs: Your total costs will include your plan premiums (if any) and your out-of-pocket expenses for copayments or coinsurance. A plan’s deductibles and maximum payments will also affect your overall costs.
Extra benefits from Medicare Advantage plans: Some plans provide benefits for dental, vision, hearing, and gym memberships.
Flexibility: If you expect to travel or live in different states, look for a plan that will cover you while you are away.
Providers: Some plans limit the amount they will pay for out-of-network providers and pharmacies. Check that the plan covers any doctors and pharmacies you expect to use.
- CMS Releases 2022 Medicare Advantage and Part D Star Ratings to Help Medicare Beneficiaries Compare Plans, CMS.
- Explore Your Medicare Coverage Options, Medicare.
- Medicare 2022 Part C and D Star Rating Technical Notes, CMS.
- 5-Star Special Enrollment Period, Medicare.