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Medicare Star Ratings

The Centers for Medicare & Medicaid Services (CMS) created a Five Star Quality Rating System that rates Medicare Advantage (MA) and Prescription Drug (PDPs or Part D) plans. Ratings are between 1 and 5 (5 being the highest) for 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.

How can I find a plan’s star rating?

You can find the star rating for your current Medicare Advantage or Prescription Drug Part D plan by using the Medicare plan finder. If you are just beginning to research your options, you can find a highly rated Medicare plan using our Medicare Questionnaire.

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How are star ratings developed?

Plan star ratings are reviewed and updated every year by CMS, with the final quality ratings released in October. CMS conducts a comprehensive review of the measures that make up the star ratings, considering the reliability of the measures, clinical recommendations, feedback received from stakeholders, and data issues. There are some Medicare plans without ratings because they are new to the marketplace.

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

Member experience with the health plan
Includes member ratings of the plan.

Health plan customer service
Includes how well the plan handles member appeals.

Member complaints and changes in the health plan’s performance
Includes how often Medicare found problems with the plan and how often people had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.

Staying healthy
Includes whether people got various screening tests, vaccines, and other check-ups to help them stay healthy.

Managing chronic (long-term) conditions
Includes how often people with certain conditions got recommended tests and treatments to help manage their condition.

Medicare Part D plans are given an overall rating based on 4 categories

Member experience with plan’s drug services
Includes member ratings of the plan.

Drug plan customer service
Includes how well the plan handles member appeals.

Member complaints and changes in the drug plan’s performance
Includes how often Medicare found problems with the plan and how often people had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.

Drug safety and accuracy of drug pricing
Includes 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.

For plans covering both health and drug services (Medicare Advantage Plan with Drug Coverage), the overall rating for quality and performance covers all the topics above.

Why are star ratings important to my health care?

Cost and coverage of your needed services and drugs are the most important considerations when choosing the Medicare plan you are enrolling in, but star ratings can provide additional points of comparison. Medicare star ratings can assist you in finding the best plan based on your health care needs and financial situation. If you are enrolled in a Medicare plan that is less than 3 stars it’s considered poor quality and is likely not providing you with the most optimal health care options for you.

When can I enroll?

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

  1. Initial Enrollment Period (new to Medicare)
  2. Open Enrollment Period (Oct. 15 – Dec. 7 each year; for those already enrolled and switching plans)
  3. During a Special Enrollment Period (SEP)

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 you have a low rated plans below 3 stars.

Special Enrollment Period to enroll in a 5-star plan

You can switch to a plan that has 5 stars for its overall star rating from December 8 to November 30, but you can only use this Special Enrollment Period once during this timeframe. Additionally, you can only switch to a 5-star Medicare Prescription Drug Plan if one is available in your area.

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

People who are enrolled in a low-performing plan, a plan that has received a rating of fewer than 3 stars for three straight years from CMS, get a one-time SEP from January 1 to December 31 to enroll in a plan that is rated 3-stars or better or a plan with no rating (since there are some plans that are too new to rate).

Please note, for both SEPs you may lose your prescription drug coverage if you move from a Medicare Advantage Plan that has drug coverage to a 5-star Medicare Advantage Plan that doesn’t. You’ll have to wait until the next Open Enrollment Period to get drug coverage, and you may have to pay a late enrollment penalty.

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