Medicare Star Ratings Explained

Star Ratings provide Medicare beneficiaries with a quality and performance score that allows them to better compare their options.

Each year, ahead of the Medicare Open Enrollment Period, the Centers for Medicare and Medicaid Services release annual Star Ratings for Medicare Advantage (Part C) and prescription drug (Part D) plans. Ratings range from 1-5 stars, with a 5-star rating considered excellent and a 1-star rating considered poor. 

How are Star Ratings determined?

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. 

Why should I care about Medicare plan 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. 

The 5-star Special Enrollment Period

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 is a one-time enrollment period available to Medicare beneficiaries between December 8th and November 30th.

Does anything happen to poor 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.