Medicare plan quality
Medicare Star Ratings: What They Tell You About a Medicare Advantage Plan
Star Ratings summarize quality and performance information. They do not tell you whether the plan fits your doctors, prescriptions, costs or preferences.
The Centers for Medicare & Medicaid Services publishes Medicare Advantage and Part D Star Ratings each year to help beneficiaries compare plan quality. Ratings range from one to five stars, with five representing the highest performance rating.
What goes into the rating
CMS combines multiple quality and performance measures
The measures and methodology can change over time. Broad categories include health outcomes, intermediate outcomes, care processes, patient experience, complaints and access.
Clinical care
Preventive services, chronic-condition management and selected health outcomes can contribute.
Member experience
Surveys, access measures, customer service and complaint information can affect ratings.
Plan performance
Appeals, timeliness, drug safety and year-over-year improvement can be included.
What the stars leave out
A quality score is not a personal plan-fit score
| Star Ratings can help describe | Star Ratings do not confirm |
|---|---|
| Measured quality and performance across the rated contract | That your primary doctor, specialists or hospitals are in network |
| Member experience and complaint-related measures | That your preferred pharmacy offers the lowest cost |
| Selected health, process and access results | That every prescription is covered on a favorable tier |
| A useful comparison signal based on historical data | That the plan has the lowest total annual cost for your healthcare use |
| Performance under CMS’s rating methodology | That its referral and prior-authorization rules suit your care |
Contract-level context
The displayed rating may cover more than one local benefit package
Medicare Advantage Star Ratings are generally calculated at the contract level. One insurance contract can contain multiple plan benefit packages. Plans within that contract may share a rating while having different premiums, networks, copays, benefits or service areas.
New and unrated plans
No rating does not automatically mean poor quality
A newer contract or a contract without enough performance data may not have a normal overall rating. The lack of a rating means there is less CMS performance history available—not that the plan is automatically good or bad.
When a plan is unrated, place additional weight on the verifiable details: provider access, prescriptions, costs, authorization rules, benefit documents and available complaint or service information.
Historical information
Ratings look backward while benefits look forward
Star Ratings use performance information collected over earlier periods. The plan you are considering has current-year premiums, networks, formularies, copays and benefits. Those details can change faster than the quality rating.
Use the rating for
- A quality comparison signal
- Supporting a close decision
- Identifying strengths or concerns to investigate
- Reviewing performance over multiple years
Do not use it for
- Provider-network confirmation
- Prescription pricing
- Estimating personal annual cost
- Replacing the Evidence of Coverage
A better comparison order
Use Star Ratings after the essentials
Verify providers and facilities
Confirm the exact doctor, hospital, office location, plan and coverage year.
Run every prescription
Compare the formulary, tier, deductible, pharmacy and coverage restrictions.
Estimate normal-year and difficult-year costs
Review premiums, common copays, major services and the medical maximum out-of-pocket.
Review network and authorization rules
Make sure the HMO, PPO, referral and prior-authorization structure fits your preferences.
Use Star Ratings and service history
When more than one plan still fits, quality information can help separate them.
Read beyond the overall number
Measure-level details may explain the score
When available in Medicare Plan Compare, review the categories beneath the overall rating. A plan may perform well in preventive care while receiving weaker member-experience or complaint results. The underlying measures can be more useful than treating one star total as a complete verdict.
Frequently asked questions
Medicare Star Ratings FAQ
Is a five-star Medicare Advantage plan automatically the best?
No. Five stars indicate high measured quality performance, not personal fit. Verify providers, prescriptions, costs, plan rules and benefits.
Are Medicare Star Ratings customer reviews?
No. Member experience and complaints contribute to the system, but CMS combines them with multiple clinical, process, access and performance measures.
Why does a plan have no Star Rating?
A newer or low-enrollment contract may not have enough data for a normal rating. Lack of a rating does not automatically mean poor quality.
Can two plans with the same star rating have different benefits?
Yes. Plans under the same rated contract may have different premiums, copays, networks, benefits or service areas.
Do Star Ratings change every year?
CMS publishes updated ratings annually. Performance and methodology can change, so review the current rating for the coverage year being considered.
Official Medicare and CMS resources
Independent Medicare guidance
Use Star Ratings without overlooking your healthcare
Benjamin Thompson can help compare Medicare Advantage quality information alongside your providers, prescriptions, expected costs and coverage preferences.
Star Ratings, benefits, networks, formularies, premiums and cost sharing can change. Review current Medicare Plan Compare information and official plan documents.