Medicare Advantage plans are rated on a scale of one to five stars, and the rating reflects how well the plan performs on quality, customer service, and health outcomes
The star rating you see on a Medicare Advantage plan is a summary score assigned by Medicare itself. It combines dozens of measures — things like how quickly the plan processes claims, whether members say their doctors listen to them, how well the plan manages chronic diseases, and whether preventive care actually happens. A plan with five stars is performing well across most of these measures. A plan with three stars is performing at an average level. A plan with one or two stars means Medicare found significant gaps in performance.
The rating system exists so you can compare plans side by side without having to read through hundreds of pages of fine print. When you're looking at plans on Medicare.gov during open enrollment, the star rating appears right next to the plan name. It's one of the quickest ways to spot which plans have strong track records and which ones have struggled.
Key Takeaways
- Star ratings range from one to five stars and measure how well a plan performs on quality, customer service, and health outcomes.
- Medicare updates star ratings every year, usually in October, so a plan's rating can change from one year to the next.
- A higher star rating often means lower out-of-pocket costs — plans with four or five stars may offer reduced copays or extra benefits.
- Star ratings are one tool for comparing plans, but you should also check whether your doctors and hospitals are in the plan's network.
- You can see detailed breakdowns of what each star rating measures on Medicare.gov, including specific scores for prescription drug coverage and member satisfaction.
How Medicare calculates the star rating
Medicare measures about 40 different performance indicators and groups them into categories. The main categories are plan quality (how well the plan manages care), member satisfaction (what members say about their experience), and prescription drug performance (how well the plan handles medication coverage and costs). Each category gets its own score, and those scores combine into the overall star rating you see.
The measures include things you might expect — like whether members can reach customer service by phone — and things that take more digging to understand, like hospital readmission rates or whether diabetic members are getting their eyes checked. Medicare collects this data from the plans themselves, from member surveys, and from healthcare claims. The rating reflects performance over a full year, and Medicare publishes new ratings every October for the following year.
What each star level actually means
A five-star plan is performing at the highest level across most measures. These plans typically have strong member satisfaction scores, fast claims processing, and good outcomes for people with chronic conditions. A four-star plan is also performing well, though it may lag slightly in one or two areas. Most plans fall into the three- to four-star range.
A three-star plan is performing at an average level — not notably strong or weak. A two-star plan has fallen below average in several areas, and a one-star plan has significant performance gaps. Plans with one or two stars are rare, because Medicare and insurers work to improve low-performing plans. If a plan stays at one star for multiple years, Medicare may not allow it to enroll new members.
How star ratings affect your costs and benefits
Plans with higher star ratings often come with financial rewards. If a plan earns four or five stars, Medicare allows the insurer to offer extra benefits — things like reduced copays for certain services, additional dental or vision coverage, or lower deductibles. These bonus benefits are one reason why a four- or five-star plan might cost you less out of pocket than a lower-rated plan, even if the monthly premium is the same.
This system is designed to reward plans that perform well and give you a concrete reason to choose them. When you're comparing plans on Medicare.gov, you'll often see that the four- and five-star plans have richer benefit packages than the three-star plans. That's not a coincidence — it's the result of the star rating system.
Where to find star ratings when you're shopping
The easiest place to see star ratings is Medicare.gov. During the open enrollment period (October 15 to December 7 each year), you can search for plans in your area and sort by star rating. The site shows the overall rating and also breaks down the rating by category — so you can see, for example, that a plan has five stars for member satisfaction but four stars for prescription drug coverage.
You can also call 1-800-MEDICARE to speak with a representative who can walk you through the ratings and help you understand what they mean for your specific situation. Some State Health Insurance information Programs (SHIPs) also offer free counseling on plan ratings and what they mean for your health needs.
Star ratings change year to year
A plan's star rating is not permanent. Medicare recalculates ratings every year based on new performance data, so a plan that had four stars one year might have three stars the next year — or vice versa. This is why it's important to check ratings every year during open enrollment, even if you've been happy with your current plan. A plan you chose because of its five-star rating might have dropped to three stars, or a plan you dismissed might have improved significantly.
When ratings change, insurers sometimes adjust their benefits and costs to reflect the new rating. A plan that lost stars might reduce its extra benefits, while a plan that gained stars might add new ones. This is another reason to review your options each October rather than assuming your current plan is still your best choice.
Star ratings are one piece of the puzzle
A high star rating is valuable information, but it's not the only thing that matters. You also need to check whether your doctors and hospitals are in the plan's network, whether your medications are covered, and whether the plan's service area includes where you live. A five-star plan is not useful to you if your cardiologist is not in the network or if your insulin is not on the formulary.
Think of the star rating as a screening tool. Use it to narrow down your choices to plans that perform well overall, then dig into the details — network, formulary, costs — to find the plan that actually works for your life. Medicare.gov lets you do this comparison step by step, and the process takes about 20 to 30 minutes if you have your current medications and doctor list handy.
Frequently Asked Questions
Can a plan's star rating change during the year?
No. Star ratings are set once a year in October and stay the same for the full calendar year. Medicare recalculates ratings based on the previous year's performance data, so changes happen only once annually. This means the rating you see in November will be the same rating in September of the following year.
What if my plan lost stars — do I have to switch?
No, you can stay with your current plan if you want to. But losing stars often means the plan is reducing its extra benefits, so it's worth comparing it to other options during open enrollment. You have the right to switch to a different plan once a year, during the October 15 to December 7 open enrollment period.
Does a higher star rating mean lower premiums?
Not necessarily. A five-star plan might have the same monthly premium as a three-star plan. The difference usually shows up in out-of-pocket costs and extra benefits — the five-star plan might have lower copays or additional dental coverage. Always compare the total cost, not just the premium.
Are star ratings the same for Medicare Advantage and Medigap plans?
No. Only Medicare Advantage plans receive star ratings. Medigap plans (supplemental insurance) are not rated by Medicare. If you're comparing a Medicare Advantage plan to Original Medicare plus a Medigap plan, you can use the star rating to evaluate the Advantage plan, but you'll need to research Medigap plans separately.
What if two plans in my area have the same star rating?
Compare them on network, formulary, and out-of-pocket costs. Two plans with the same overall rating might perform differently in specific areas — one might have better prescription drug coverage, while the other has a larger hospital network. Look at the detailed breakdown on Medicare.gov to see where each plan's strengths are.