What is the Medicare 5-Star Rating System?

Published by: Medicare Made Clear

Medicare Star Ratings Explained

The Centers for Medicare and Medicaid Services (CMS) created a star rating system to help Medicare-eligible individuals and caregivers quickly compare the performance and quality of Medicare Advantage plans and Part D prescription drug plans. This rating system helps Medicare shoppers and caregivers evaluate different plans – an important factor for someone enrolling for the first time or considering a change during the Medicare Annual Enrollment Period.

 

 

How are Medicare Plans Rated?

 

CMS rates Medicare Advantage and Part D plans annually, using a scale from one to five, with more stars equating to better performance and quality. A five-star rating is the highest a Medicare Advantage or Part D plan can receive, and half-ratings also exist (1.5, 2.5, 3.5, 4.5).

 

Here’s what the star ratings mean:

 

  • 5-star rating: excellent performance
  • 4-star rating: above-average performance 
  • 3-star rating: average performance
  • 2-star rating: below-average performance
  • 1-star rating: poor performance

 

Star ratings are released by CMS around early October, just before the Medicare Annual Enrollment Period begins. CMS evaluates and scores three types of Medicare plans each year.

 

1. Medicare Advantage plans with prescription drug coverage (MA-PD)

 

2. Medicare Advantage plans without prescription drug coverage (MA only)

 

3. Standalone Part D prescription drug plans (PDP)

 

Depending on the type of plan being evaluated, CMS uses anywhere from 12 to 38 quality and performance measures.

 

 

Why is the Medicare Star Rating Important?

 

A Medicare plan’s star rating is important because it can help you when comparing different plans. You should not use a star rating as the only factor when making a final decision though. Some plans that have fewer than five stars may actually be a better fit for you. Use the Medicare star rating as just a single factor of evaluation. Your health, lifestyle, and financial needs should always be the final determining factors, and it’s important to read the details of each plan.

 

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What determines a Medicare Advantage or Part D plan’s star rating?

 

Below are some examples of quality and performance measures CMS may use to determine the star rating for a Medicare Advantage or Part D plan. You’ll notice some are more about the plan and plan provider, while others are specific to a health care service or item.

 

Quality and performance measures related to the plan or plan provider:

 

  • Customer service
  • Care coordination
  • Complaints about the plan
  • Getting needed care
  • Rating of health care quality
  • Members choosing to leave the plan
  • Getting appointments and care quickly

 

Quality and performance measures related to health services:

 

  • Breast cancer screening
  • Diabetes care
  • Rheumatoid arthritis management
  • Annual flu vaccine
  • Monitoring physical activity
  • Colorectal cancer screening
  • Getting needed prescription drugs
  • Medication adherence for cholesterol or diabetes medications

 

 

More information about the Medicare plan star ratings for 2022

 

Here are some statistics from CMS about the 2022 star ratings:1

     

  • Approximately 68% of Medicare Advantage plans with included prescription drug coverage will have an overall rating of four stars or more
  • The number of plans with at least four stars has increased by 49% since 2021
  • Approximately 90% of people currently enrolled in Medicare Advantage plans with included prescription drug coverage are enrolled in a plan that has at least a four-star rating
  • Adjustments were made for the 2022 star ratings due to the possible impact of COVID-19

It’s important to note that the 2022 star ratings may decrease for 2023 based on the potential removal of the COVID-19 impact adjustments.

 

 

How Do I Find My Medicare Plan’s Rating?

 

To find a Medicare plan’s star rating, use the Medicare.gov plan finder tool  , where you can simultaneously compare star ratings, as well as plan benefits and costs.

 

Many plan providers will indicate if a plan has a five-star rating, but you can always directly ask your Medicare plan provider by contacting them via phone or online.

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