Medicare Star Ratings

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.

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.

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.

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.

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.

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)

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.