There is no single "highest rated" Medicare Advantage plan that works for everyone

Medicare Advantage plans are rated by different organizations using different measures, and the ratings depend on what matters most to you. The Centers for Medicare & Medicaid Services (CMS) publishes star ratings based on plan performance in areas like customer service, prescription drug coverage, and preventive care. Consumer Reports and J.D. Power also rate plans, but they measure different things. A plan with five stars for customer service might have three stars for drug coverage. The plan that is best for you depends on your doctors, your medications, your budget, and how much you value convenience versus cost.

Key Takeaways

  • Medicare Advantage plans receive star ratings from CMS (1 to 5 stars) based on customer satisfaction, care quality, and drug coverage, but no single plan is "best" for all seniors.
  • You can compare star ratings, premiums, and coverage details on Medicare.gov using the plan finder tool, which shows you plans available in your zip code.
  • The most important ratings for you depend on your situation: if you take many medications, drug coverage ratings matter most; if you have a chronic condition, care quality ratings matter most.
  • Plans change their coverage, premiums, and networks every year, so a highly rated plan this year may not be available or may change next year.

How CMS star ratings work and what they measure

Every Medicare Advantage plan receives a star rating from 1 to 5 based on how well it performs in specific areas. CMS measures things like how quickly the plan answers the phone, whether members say they would recommend the plan to a friend, how many preventive care visits members complete, and whether the plan covers the drugs members need. Plans with ratings of 4.5 stars or higher are considered high-performing. A plan might score 5 stars for customer service but 3 stars for drug coverage, so the overall rating is a mix.

The star ratings change every year, usually in October, based on data from the previous year. This means a plan that was highly rated last year might have a lower rating this year if its performance changed. You can find the current star ratings for plans in your area on Medicare.gov by entering your zip code in the plan finder tool. The tool shows you each plan's overall star rating and breaks down the ratings by category so you can see which areas the plan performs well in and which areas it does not.

What to look for beyond the star rating

Star ratings are one piece of information, but they do not tell you whether a plan will work for your specific situation. Before you choose a plan, check whether your doctors are in the plan's network. Many Medicare Advantage plans have smaller networks than Original Medicare, which means your current doctor might not be covered. If your doctor is not in the network, you will have to pay more to see them or switch to a different doctor. You can search for doctors and hospitals in a plan's network on Medicare.gov or by calling the plan directly.

If you take prescription medications, look at the plan's formulary, which is the list of drugs the plan covers. Even if a plan has a high star rating for drug coverage, it might not cover the specific medications you take. You can search for your medications on Medicare.gov or the plan's website to see whether they are covered and how much you will pay. If your medications are expensive or you take many of them, the plan's drug coverage matters more than its overall star rating.

Check the plan's out-of-pocket costs, including the monthly premium, the deductible, and the copays for doctor visits and hospital stays. A plan with a low premium might have high copays, which means you pay more each time you see a doctor. A plan with a high premium might have low copays. Calculate what you would pay under each plan based on how often you see doctors and what services you use.

Where to find and compare plan ratings

Medicare.gov is the official source for Medicare Advantage plan information and star ratings. Go to the plan finder tool, enter your zip code, and select the plans you want to compare. The tool shows you each plan's star rating, premium, deductible, and coverage details. You can filter by star rating to see only plans with 4 stars or higher, or you can sort by premium to see the least expensive plans first.

Consumer Reports and J.D. Power also rate Medicare Advantage plans, but their ratings are based on different measures than CMS. Consumer Reports surveys members about their satisfaction with the plan and whether they would recommend it. J.D. Power measures customer satisfaction and the quality of the plan's customer service. These ratings may differ from the CMS star ratings because they focus on different aspects of the plan. You can read these reviews on the Consumer Reports and J.D. Power websites, though some content may require a subscription.

Your State Health Insurance information Program (SHIP) offers free counseling to help you compare plans. SHIP counselors can answer questions about coverage, costs, and how to switch plans. You can find your state's SHIP by calling 1-800-MEDICARE or visiting the SHIP locator on Medicare.gov.

How plan ratings and coverage change year to year

Medicare Advantage plans change every year. A plan that was highly rated and had low premiums this year might have a lower rating, higher premiums, or different coverage next year. Some plans leave the Medicare market entirely, which means you will have to choose a different plan. Other plans merge with other plans or change their service areas, so they may not be available in your zip code anymore.

During the annual enrollment period from October 15 to December 7, you can switch to a different Medicare Advantage plan or switch to Original Medicare. If your current plan is no longer available or if the coverage or costs change in a way that does not work for you, this is when you can make a change. CMS sends you a notice in the fall that explains any changes to your current plan, so read that notice carefully to see whether your plan is still a good fit.

What to do if you want to switch to a higher-rated plan

If you find a plan with a higher star rating or better coverage for your situation, you can switch during the annual enrollment period. You do not need to wait until your birthday or a special event. Go to Medicare.gov, use the plan finder to compare plans, and select the plan you want. You can also call 1-800-MEDICARE to switch over the phone, or you can contact the new plan directly and ask them to help you switch.

Your coverage with the new plan starts on January 1 of the following year. Your old plan coverage ends on December 31. Make sure you understand the new plan's coverage, network, and costs before you switch. If you switch plans and then change your mind, you have until January 31 to switch back to your old plan or choose a different plan.

Questions to ask your doctor or plan about ratings and coverage

Before you choose a plan based on its star rating, talk to your doctor about whether the plan's network includes them and whether the plan covers your medications and treatments. Ask your doctor whether they have had good experiences with the plan or whether they have heard complaints from other patients. If your doctor is not in the plan's network, ask whether they can refer you to a doctor in the network or whether they can see you as an out-of-network provider.

Call the plan directly and ask about coverage for any services you use regularly, such as physical therapy, mental health care, or specialist visits. Ask about the plan's customer service and how long it takes to get approval for treatments. Ask whether the plan has any extra benefits, such as dental or vision coverage, that might be valuable to you.

Frequently Asked Questions

What does a 5-star Medicare Advantage plan mean?

A 5-star rating means the plan performed very well in the areas CMS measured, such as customer service, care quality, and drug coverage. However, a 5-star rating does not mean the plan is the best choice for you personally. It means the plan performed well on average for its members. Your doctors might not be in the network, or the plan might not cover your medications, even if it has 5 stars.

Can I switch to a higher-rated plan anytime during the year?

No. You can switch plans only during the annual enrollment period from October 15 to December 7, or if you have a may have access to life event such as moving, losing other insurance, or getting married. If you miss the enrollment period and do not have a may have access to event, you will have to wait until the next October to switch.

If a plan has high star ratings, will my out-of-pocket costs be lower?

Not necessarily. Star ratings measure quality and customer satisfaction, not cost. A plan with 5 stars might have high premiums and high copays. A plan with 3 stars might be less expensive. You need to compare both the star ratings and the costs to find the plan that works best for your budget and your health needs.

What should I do if my current plan's rating drops next year?

If your plan's rating drops, review the details of what changed. Sometimes a plan's rating drops because of one area, such as customer service, while other areas remain strong. If your doctors are still in the network and your medications are still covered, you might decide to stay. If the rating drop reflects problems that matter to you, you can switch to a different plan during the next enrollment period.

How do I know if a plan's star rating is based on my specific health needs?

Star ratings are based on how the plan performs for all its members, not for people with your specific condition. If you have diabetes, for example, the plan's overall star rating does not tell you how well it covers diabetes care. Look at the plan's specific ratings for chronic disease management and ask the plan directly how they support members with your condition.