Key Takeaways

  • Medicare Star Ratings were developed to give people more information to consider when choosing a health or prescription drug plan.

  • There are star ratings for Medicare Advantage (MA) plans and for Part D Prescription Drug Plans.

  • Generally, plans with less than 3 stars are considered to be of poor quality and may not meet your health needs.  

The Medicare Stars is a rating system developed by the Centers for Medicare & Medicaid Services (CMS). The system rates Medicare Advantage (MA) and Prescription Drug (PDPs or Part D) plans on a 5-star scale with 1 being the lowest and 5 being the highest score. Measurements focus on health plan quality based on measurements of customer satisfaction and quality of care the plan delivers.

The goal of the ratings is to improve the quality of care and general health status for Medicare beneficiaries and support the efforts of CMS to improve the level of accountability for the care provided by physicians, hospitals, and other providers.

Finding a Plan’s Star Rating

You can find the Star Ratings for current Medicare Advantage or Prescription Drug Part D plans by using the Medicare Plan Finder tool or by taking our Medicare Questionnaire.

Star Ratings Review

CMS reviews and updates star ratings annually. The final ratings are released in October. If plans are new to the marketplace, they will not have ratings.

Medicare Advantage plans are given an overall rating based on 5 categories:

  1. Member experience with the health plan. This is measured by member ratings of the plan.
  2. Customer service. This is based on how well the plan handles member appeals.
  3. Plan performance. This focuses on member complaints and changes in the plan’s performance. It includes how often Medicare found problems with the plan, how often members had problems with the plan, and how much the plan's performance has improved over time.
  4. Chronic conditions. This is based on how often members with certain conditions got recommended tests and treatments to help manage their condition.
  5. Staying healthy. This measures whether members got various screening tests, vaccines, and other check-ups to help them stay healthy.

Medicare Part D (prescription drug) plans are given an overall rating based on 4 categories

  1. Member experience with the drug plan. This is based on member ratings of the plan.
  2. Customer service. This is based on how well the plan handles member appeals.
  3. Plan performance. This focuses on member complaints and changes in the plan’s performance. It includes how often Medicare found problems with the plan, how often people had problems with the plan, and how much the plan's performance has improved (if at all) over time.
  4. Drug safety and pricing. This measures how accurate the plan’s pricing information is and how often people with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.

The Importance of Star Ratings on Health

Star ratings provide additional points of comparison. along with costs and coverage when choosing a Medicare plan. A Medicare plan with less than 3 stars is considered poor quality and is likely not providing the most optimal health care options.

Enrolling in a 5-star plan

Enrollment in a Medicare Advantage (MA) or Medicare Prescription Drug (Part D) star rated plan can occur any time of the year using the enrollment periods below.

  1. Initial Enrollment Period (new to Medicare). This period is the three months before, the month of, and the three months after your 65th birthday.
  2. Open Enrollment Period (Oct. 15 – Dec. 7 annually, for those already enrolled in Medicare and want to switch plans).
  3. During a Special Enrollment Period (SEP).

Special Enrollment Period to enroll in a 5-star plan

Switching to a plan that has overall 5 stars can occur between Dec. 8 and Nov.  30, but is limited to one usage during this timeframe. Switching to a 5-star Medicare Prescription Drug Plan can only happen if one is available in the local area.

When is my Special Enrollment Period?

December 8 to November 30 if you switch to a 5-star plan.

 

January 1 to December 31 if your current plan is below 3 stars.

Special Enrollment Period to dis-enroll from lower-rated plans

People who are enrolled in a low-performing plan (this is a plan that has a rating of fewer than 3 stars for three straight years from CMS), get a one-time SEP from Jan. 1 to Dec. 31 to enroll in a plan that is rated 3-stars or better. This also includes the option to switch to a plan with no rating, since some plans are too new to the program to rate.  

For both SEPs, prescription drug coverage may be lost if moving from a Medicare Advantage Plan that has drug coverage to a 5-star Medicare Advantage Plan that doesn’t. You may have to wait until the next Open Enrollment Period to get drug coverage and end up with a late enrollment penalty.