What Medicare Star Ratings Tell You
Medicare Star Ratings are a scoring system that shows how well Medicare insurance plans and the doctors and hospitals in those plans perform on quality and service measures. The Centers for Medicare & Medicaid Services (CMS) publishes these ratings every year so you can compare plans side by side. Each plan gets a rating from 1 to 5 stars, with 5 stars being the highest.
The ratings measure real things: whether members got their prescriptions filled on time, whether preventive care visits happened, how quickly the plan answered phone calls, and whether members reported good experiences with their doctors. A plan with 4 or 5 stars has generally performed better on these measures than a plan with 2 or 3 stars.
You can see these ratings on Medicare.gov when you search for plans in your area during the annual enrollment period (October 15 through December 7 each year). The ratings change yearly because CMS collects new data and measures performance again.
Key Takeaways
- Medicare Star Ratings range from 1 to 5 stars and measure how well plans handle prescriptions, preventive care, customer service, and member satisfaction.
- CMS publishes new ratings every year, so a plan's rating can go up or down based on its performance that year.
- You can compare star ratings for all plans available in your area on Medicare.gov during open enrollment.
- A higher star rating does not may provide the plan is right for you — you also need to check whether your doctors and medications are covered.
- Plans with 4 or 5 stars may offer bonus benefits like extra dental or vision coverage, though this varies by plan.
What Gets Measured in the Star Rating
CMS measures dozens of specific things to create the overall star rating. These include whether members took their blood pressure medicine as prescribed, whether diabetic members got their annual eye exams, and whether the plan processed claims correctly and on time. The system also measures how satisfied members are with their plan and their doctors.
Customer service is part of the rating too. CMS tracks how quickly the plan answers the phone, how often callers get transferred, and whether the plan resolves problems the first time. If a plan consistently puts you on hold for 20 minutes or transfers you three times, that shows up in the rating.
Drug coverage performance matters as well. The rating includes whether the plan filled prescriptions without delays and whether members had trouble getting their medications approved. If a plan frequently denies coverage for common drugs, that affects the star rating.
How to Find and Compare Star Ratings
Go to Medicare.gov and use the plan comparison tool. Enter your zip code and the tool will show you every Medicare Advantage and Part D plan available in your area. Each plan's star rating appears next to its name. You can sort the results by star rating to see the highest-rated plans first.
When you click on a specific plan, you can see the breakdown of its rating — which measures it scored well on and which ones were lower. For example, you might see that a plan scored 5 stars for prescription drug handling but 3 stars for customer service. This detail helps you decide whether the plan's strengths match what matters most to you.
You can also see how a plan's rating has changed over the past few years. If a plan went from 3 stars to 5 stars, it made real improvements. If it dropped from 4 stars to 2 stars, something changed in how it operates.
Star Ratings and Bonus Benefits
Plans with 4 or 5 stars may offer bonus benefits that plans with lower ratings do not. These might include extra dental coverage, vision benefits, hearing aids, or fitness program memberships. CMS allows high-rated plans to add these benefits because the plans have proven they can deliver good service.
However, not every 4 or 5-star plan offers the same bonuses. One plan might include dental and vision, while another includes fitness and transportation. You need to check what each specific plan offers, not just look at the star rating.
These bonus benefits can change year to year. A plan that offered dental coverage last year might drop it this year, or add hearing coverage instead. Always check the current plan details during open enrollment rather than assuming the benefits are the same as last year.
What Star Ratings Do Not Tell You
A high star rating does not mean your doctor is in the plan's network or that your medications are covered. You could find a 5-star plan that does not include your cardiologist or does not cover the blood pressure medicine you take. Before you choose a plan based on its star rating, check whether your doctors and drugs are covered.
Star ratings also do not account for cost differences. A 3-star plan might have lower monthly premiums and lower out-of-pocket costs than a 5-star plan. If you are on a tight budget, the lower-cost plan might be the better choice for you even if it has fewer stars.
The rating reflects how the plan performed last year, not how it will perform this year. A plan with 5 stars might hire new staff or change its processes, which could affect next year's rating. Similarly, a plan with 2 stars might make major improvements and earn a higher rating the following year.
Using Star Ratings as One Tool Among Many
Think of the star rating as one piece of information, not the whole picture. Start by checking whether your doctors and medications are covered in the plan. Then look at the cost — premiums, deductibles, and copays. After you have narrowed down plans that work for your health needs and budget, use the star rating to choose between them.
If you are choosing between two plans that both cover your doctors and medications and cost about the same, the one with the higher star rating is probably the better choice. But if the higher-rated plan does not include your doctor or costs significantly more, the lower-rated plan might serve you better.
You can also read member reviews on Medicare.gov. These are comments from people who actually use the plan, and they sometimes mention things the star rating does not capture — like whether the plan's website is straightforward to use or whether the customer service team is friendly.
When Star Ratings Change and What It Means
Every October, CMS releases new star ratings for the coming year. A plan's rating can go up, go down, or stay the same depending on how it performed during the measurement period. If a plan you are considering had 3 stars last year but has 4 stars this year, that is a sign it made improvements.
Sometimes a plan's rating drops because the plan changed — maybe it cut staff or changed its pharmacy network. Other times the rating drops because CMS changed how it measures performance or because the plan's member population changed. The reason matters, so if you see a big drop, you can call the plan and ask what happened.
Plans with consistently high ratings year after year have proven they can deliver good service over time. Plans that jump between high and low ratings might be less stable or predictable.
Frequently Asked Questions
Does a 5-star rating mean the plan is perfect?
No. A 5-star rating means the plan performed well on the measures CMS tracks, but it does not mean every member will have a perfect experience. Some members might have problems that the rating does not capture. It also does not may provide your specific doctor or drug is covered.
Can I switch plans if I chose one with a low star rating?
Yes. During the annual open enrollment period (October 15 through December 7), you can switch to any other plan available in your area, regardless of your current plan's star rating. If you have a Medicare Advantage plan, you can also switch back to Original Medicare during this time.
What if my favorite doctor is in a low-rated plan?
You have to weigh what matters most to you. If your doctor is essential to your care, staying with that plan might be worth accepting a lower star rating. But you could also ask your doctor whether they are in-network for any higher-rated plans in your area.
How often do star ratings change?
CMS releases new star ratings every October for the plans that will be available the following year. So the ratings you see in October 2024 reflect how plans performed in 2023 and early 2024, and those ratings explore to coverage starting January 1, 2025.
Can I see what specific measures a plan scored on?
Yes. On Medicare.gov, when you click on a plan's name, you can see the breakdown of its rating by category — such as drug coverage, preventive care, and customer service. This shows you where the plan is strong and where it scored lower.