Breaking Down Medicare Start Ratings
And Why They Matter
Medicare Star Ratings provide a valuable tool for comparing the quality and performance of Medicare plans before you enroll. Whether you’re signing up for Medicare for the first time or considering switching plans during open enrollment, understanding what these ratings mean can help you make an informed decision about your healthcare coverage.
In this article
What Are Medicare Star Ratings?
The Star Ratings system was developed by the Centers for Medicare & Medicaid Services (CMS) to evaluate Medicare Advantage (Part C) and Medicare Prescription Drug (Part D) plans on a quality scale. Plans receive ratings from 1 to 5 stars, with 5 being the highest possible score (excellent) and 1 being the lowest score (poor).
These ratings focus on health plan quality based on measurements of customer satisfaction and the quality of care a plan delivers. The primary goal of this system is to improve the quality of care and overall health status for Medicare beneficiaries while increasing accountability among healthcare providers.
CMS reviews and updates Star Ratings annually, with final ratings typically released in October of each year. The ratings that appear on Medicare Plan Finder for 2025 open enrollment will impact Medicare Advantage quality bonus payments in 2026.
How Medicare Star ratings Are Determined
Medicare Advantage (Part C) Plans
Medicare Advantage plans are evaluated on five primary categories:
- Member experience with the health plan: This measures members’ personal reviews and satisfaction with their plan
- Customer service: This category evaluates how well the plan responds to and handles member complaints and appeals.
- Plan performance: This focuses on member complaints and changes in the plan’s performance, including how often Medicare found problems with the plan and how much the plan’s performance has improved over time.
- Chronic conditions management: This assesses how well the plan helps members manage long-term health conditions.
- Staying healthy: This category measures whether members received appropriate screening tests, vaccines, and preventive check-ups.
Medicare Part D (Prescription Drug) Plans
Part D plans are rated based on four key categories:
- Member experience with the drug plan: Based on members’ personal reviews of the Part D plan.
- Customer service: How well the plan manages member complaints and claim appeals.
- Plan performance: This evaluates member complaints and changes in performance over time.
- Drug safety and pricing: This category measures the accuracy of pricing information and whether people with certain medical conditions are prescribed drugs in a clinically recommended manner.
In total, MA-only contracts (without Part D coverage) are rated on up to 30 measures, while PDP contracts are rated on up to 12 measures. For each measure, CMS establishes thresholds called “cut points” that determine whether a contract’s performance receives a 1-, 2-, 3-, 4-, or 5-star rating.
The Significance of Star Ratings
For Consumers
Star ratings provide additional points of comparison, along with costs and coverage, when shopping for a Medicare plan. They help you:
- Identify high-quality healthcare plans
- Compare plans based on objective quality measures
- Understand member satisfaction levels
- Assess how well plans manage chronic conditions
- Evaluate customer service performance
A plan’s star rating can significantly impact your healthcare experience. Higher-rated plans typically offer better quality care, improved customer service, and greater focus on preventive services.
For Healthcare Providers and Plans
Star ratings have significant implications for Medicare Advantage Organizations (MAOs):
- Financial Impact: The 2025 Star Ratings will impact 2026 MA quality bonus payments. Plans earning four or more stars are eligible for quality bonus payments and higher rebate percentages.
- Enhanced Benefits: Health plans that receive bonus payments must reinvest them to make plan products more attractive to beneficiaries through additional or enhanced benefits, such as reduced premiums or expanded coverage.
- Special Enrollment Period: Plans with a 5-Star rating are granted a special enrollment period, allowing Medicare beneficiaries to enroll throughout the year rather than just during the annual enrollment period.
Recent Trends in Medicare Star Ratings
The 2025 Medicare Advantage Star Ratings show some notable changes from previous years:
- Only seven Medicare Advantage plans received an overall 5-Star Rating in 2025, compared with 38 in 2024.
- Approximately 40% of MA-PDs (209 contracts) that will be offered in 2025 earned four stars or higher for their 2025 overall rating.
- Medicare Advantage plans with prescription drug coverage have an average overall star rating of 3.95 for 2025.
- CMS increased many measure-level cut points from the 2024 Star Ratings, requiring MAOs to achieve higher performance on these measures to receive a four or higher Star Rating.
This decline in overall star ratings across the industry has significant implications for both consumers and healthcare organizations, as fewer plans qualify for quality bonus payments, resulting in less reinvestment of funds for enhanced benefits.
How to Find and Use Medicare Star Ratings
When shopping for Medicare plans, you can find Star Ratings for current Medicare Advantage or Part D plans by using the Medicare Plan Finder tool at www.medicare.gov. A good broker will also help identify higher rated plans in your area that align with your health needs.
Five-star plans will have a special star icon beside them for easy identification.
Here’s how to interpret the ratings:
- 5 stars: Excellent
- 4 stars: Above average
- 3 stars: Average
- 2 stars: Below average
- 1 star: Poor
Remember, because this year’s data is used for next year’s star ratings, plans that are new will not have enough data to show a rating. This does not mean that they are inherently bad plans, but more research may be needed.
Considerations When Using Star Ratings
While star ratings are valuable, they should be considered alongside other factors when selecting a Medicare plan:
- Coverage needs: Ensure the plan covers your specific healthcare needs, including prescription medications.
- Cost considerations: Compare premiums, deductibles, and out-of-pocket maximums.
- Provider network: Check if your preferred doctors and hospitals are in-network.
- Star ratings: Use these as an indicator of quality and customer satisfaction.
Benefits of Choosing a Highly-Rated Plan
Selecting a Medicare plan with a high star rating can provide several advantages:
- Greater focus on preventive care: These plans typically emphasize early detection of disease through preventive services.
- Better chronic condition management: Higher-rated plans often have programs specifically designed to help manage chronic conditions.
- Improved customer service: These plans generally offer superior customer service and responsiveness to member concerns.
- Enhanced benefits: Plans with higher ratings may offer additional benefits due to quality bonus payments they receive.
Takeaways
Medicare Star Ratings serve as a valuable tool for comparing the quality of Medicare Advantage and Part D prescription drug plans. They provide objective measurements of plan performance across multiple categories, helping you make informed decisions about your healthcare coverage.
When shopping for a Medicare plan, take the time to check and compare star ratings along with other factors like cost and coverage. While a 5-star plan represents the gold standard in quality, any plan with 4 or more stars is considered above average and likely to provide quality care and service.
By understanding how Medicare Star Ratings work and what they measure, you can make a more informed choice about your healthcare coverage—one that may lead to better health outcomes and greater satisfaction with your Medicare plan.
If you have any questions about the plans offered in your area or need help determining if a plan is good fit for your needs, reach out and we can talk.
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