Medicare CMS Star Ratings Explained
There are a lot of Medicare insurance options out there. To start, you can have Original Medicare or Medicare Advantage. If you choose Original Medicare, you can also choose to add one of ten Medigap plans and/or a prescription drug plan. If you choose to enroll in Medicare Advantage, plan availability depends on where you live, but Medicare beneficiaries have an average of 43 plans to choose from. The CMS star rating system gives people an idea of the quality and performance of Medicare plans to give them a metric with which to compare their options.
What are Medicare star ratings?
Medicare is intended to provide high-quality, affordable care to older Americans. To help consumers choose high-quality Medicare coverage, The Centers for Medicare and Medicaid Services (CMS) releases annual star quality ratings for Medicare Advantage (Part C) plans and prescription drug (Part D) plans.
The Medicare plan star ratings range from 1-5 stars. A plan with a 5-star rating is considered excellent and a plan with a 1-star rating is considered poor quality.
How are star ratings calculated?
Medicare uses member satisfaction surveys, plan details, and information from healthcare providers to determine star ratings for Medicare Advantage and prescription drug plans. A plan’s ratings are intended to reflect the customer’s experience and measure the overall performance of a plan.
Where to find Medicare plan star ratings information
If you use the Medicare Plan Finder tool, you’ll see a star rating near the top of every insurance policy listing. You can also use the filters at the top of the tool to filter for plans based on the CMS star rating.
You can also get in touch with one of our licensed Medicare Advisors to hear about all the plans available in your area. Every one of our Advisors can look at details like a plan’s drug coverage, doctors in network, and star rating. We’ll also help you understand the differences between plans to ensure you make an informed decision when choosing the best Medicare coverage for your needs. Call 855-900-2427 or schedule a chat today for free information and advice tailored to you!
When are star ratings released?
CMS releases star ratings for Medicare plans every year in October (ahead of the Medicare Open Enrollment Period).
What types of Medicare plans get star ratings?
Only Medicare Advantage and prescription drug plans receive CMS star ratings. Original Medicare is run by the federal government and is the same for everyone, so there’s no need for a rating system. Every Medigap plan of the same letter type (e.g., every Medigap Plan G) has the same coverage and out-of-pocket costs. While premiums and quality of customer service can vary between insurance carriers and policies, plan performance remains the same and consumer satisfaction is generally high.
How and when to use CMS star ratings
Just like any product or service, quality matters for your Medicare coverage—and not all plans are created equally. When you’re comparing Medicare plans, star ratings can help you narrow down your options. If you’re unhappy with your current plan you may also be able to switch to a 5-star plan outside of the Medicare Open Enrollment Period. You’d do this by using the 5-Star Special Enrollment Period.
What is the 5-Star Special Enrollment Period?
The 5-Star Special Enrollment Period is a one-time enrollment period available to Medicare beneficiaries between December 8th and November 30th. If a Medicare Advantage, prescription drug, or Medicare Cost Plan with a 5-star rating is available in your area, you can use the 5-star Special Enrollment Period to change from your current plan to the 5-star plan. This period may allow you to change your plan outside of the fall Open Enrollment Period and the Medicare Advantage Open Enrollment Period.
Does anything happen to low-quality plans?
Medicare introduced the “Consistent Poor Performer Notice” to let beneficiaries know they’re on a plan that’s a “consistent poor performer.” This means the plan has scored a star rating of less than three stars for three or more years. The notice, sent in late October, encourages beneficiaries to use the Medicare Open Enrollment Period to review their options and enroll in a higher-quality plan.
During the Open Enrollment Period, which occurs every year between October 15th and December 7th, you can work with a Chapter Medicare Advisor to compare your options and find a plan that provides better quality and value. If you miss the Open Enrollment Period, after January 1st, you have a one-time chance to choose and enroll in a plan rated three stars or better.
If you’re unhappy with your plan and not sure if you’re eligible to change it, book an appointment with a Chapter Medicare Advisor to understand your options.