Frequently Asked Questions
What are Medicare star ratings?
CMS (Centers for Medicare and Medicaid Services) rates every Medicare Advantage and Part D plan annually on a 1–5 star scale based on quality metrics: how well the plan manages chronic conditions, how timely and accessible care is, member satisfaction, how often members get recommended preventive care, and how quickly the plan resolves appeals and complaints. Five stars is the highest possible rating.
Does a higher star rating mean better care?
Generally yes — star ratings correlate with better health outcomes, more timely access to care, fewer denied claims, faster appeals resolution, and higher member satisfaction. However, star ratings are averages across a large membership — individual experiences vary. A 4-star plan may work better for your specific doctors and drug needs than a 5-star plan that doesn't include your providers.
Where can I see Medicare star ratings?
Go to Medicare.gov Plan Finder and enter your ZIP code. Plans are displayed with their star rating (out of 5 stars) prominently visible. You can filter results by star rating — for example, showing only 4-star and 5-star plans. You can also find detailed breakdowns of what contributed to each plan's rating.
What is a 5-star plan special enrollment?
Any Medicare beneficiary can switch to a Medicare Advantage or Part D plan rated 5 stars at any time from January 1 through November 30 — without waiting for AEP. This is the 5-Star Special Enrollment Period. Changes take effect the first of the month after enrollment. Not all areas have 5-star plans — check Plan Finder to see if one is available where you live.
Do star ratings change every year?
Yes — CMS calculates star ratings annually, typically releasing fall ratings each October for the upcoming plan year. A plan that earned 4 stars this year may earn 3 stars or 5 stars next year based on performance data. During AEP, you can see each plan's rating for the upcoming year. A plan's rating trend (improving or declining) is worth considering alongside the current rating.
Every Medicare Advantage and Part D plan in the country is rated 1–5 stars by the federal government — and this rating is based on real performance data about care quality, member experience, and plan operations. Yet most seniors comparing plans during AEP focus primarily on premium and drug coverage, overlooking a quality signal that matters significantly for their actual healthcare experience.
What Star Ratings Actually Measure
CMS uses more than 40 individual measures across five broad categories to calculate star ratings:
- Staying healthy: How often members get recommended preventive screenings and vaccines
- Managing chronic conditions: Blood pressure control, blood sugar management, cholesterol management for members with diabetes, heart disease, and other conditions
- Member experience: Survey results on how easy it is to get care, how well doctors communicate, how often care is coordinated
- Complaints and access: How quickly the plan resolves appeals, how many members file complaints with CMS, how often prior authorizations are denied
- Drug plan performance: Medication safety, adherence, patient counseling quality
What Each Star Level Means in Practice
| Stars | Rating | What It Typically Means |
|---|---|---|
| ⭐⭐⭐⭐⭐ | Excellent | Top-performing plan; strong quality across all measures |
| ⭐⭐⭐⭐ | Above Average | Good quality; most members have positive experiences |
| ⭐⭐⭐ | Average | Meets minimum standards; some areas need improvement |
| ⭐⭐ | Below Average | Multiple problem areas; consider switching |
| ⭐ | Poor | Significant quality problems; strong reason to switch |
How to Use Star Ratings During AEP
Star ratings are most useful as a filter, not as the sole criterion. In Medicare.gov Plan Finder:
- Start by filtering to show only 4-star and 5-star plans — this eliminates poor-performing plans immediately
- Among the remaining plans, compare by total annual cost (your specific drugs + premium)
- Verify your doctors are in-network for the top 2–3 plans by cost
- Your final choice is the lowest total annual cost plan that includes your doctors, drugs, and carries 4+ stars
Avoid: choosing a 3-star plan just because it has a $0 premium. The lower quality of care coordination and prior authorization practices may cost you significantly more in time and stress than the premium savings.
The 5-Star Advantage — Switch Anytime
If a 5-star plan exists in your area, you can switch to it at any time January 1–November 30 — not just during AEP. Check Plan Finder after January 1 to see if any new 5-star plans were rated for your area. This year-round switching right is one of the most underused Medicare benefits available.
- Filter Medicare Plan Finder to show 4+ star plans before comparing costs
- Avoid plans rated below 3 stars — quality problems affect real care experiences
- Check if a 5-star plan is available in your area — you can switch anytime Jan 1–Nov 30
- Star ratings change annually — check them every AEP, not just once
→ Use Medicare Plan Finder — Step-by-Step
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