Medicare Advantage plans offer an alternative to Original Medicare. These plans include Medicare Parts A and B coverage, and some also include prescription drug coverage (Medicare Part D).
Older adults planning to enroll in Medicare Advantage or switch to a new Medicare Advantage should consider using Medicare Star Ratings to help in their decision making. These ratings are released ahead of open enrollment and are designed to make comparing plans easier.
- Medicare Advantage plans combine Medicare Parts A and B into a single coverage option.
- The U.S. Centers for Medicare & Medicaid Services (CMS) issues Medicare Star Ratings to help consumers compare Medicare Advantage and Medicare Part D plans ahead of the annual open enrollment period.
- Medicare Star Ratings range from one to five stars, with one being the lowest rating and five stars the highest.
- Medicare Advantage plans with higher star ratings may offer more features and benefits than lower-rated plans.
What Are Medicare Star Ratings?
Medicare Star Ratings is a rating system developed by the U.S. Centers for Medicare & Medicaid Services. These ratings are designed to help older adults who are planning to enroll in a Medicare Advantage plan for the first time or switch to a new Medicare Advantage plan evaluate their options. Medicare Star Ratings also extend to Medicare Part D prescription drug plans.
The Medicare Star Ratings system operates on a scale from one to five. A one-star rating represents the lowest score, while a five-star rating represents the highest. The ratings are released annually ahead of the fall Medicare open enrollment period, from Oct. 15 to Dec. 7 in 2022.
Medicare Star Ratings are not the same as the five-star quality rating system that the U.S. Centers for Medicare & Medicaid Services uses to evaluate nursing home facilities.
How Do Medicare Star Ratings Work?
Medicare Star Ratings are based on up to 38 unique quality and performance measures. The ratings apply to Medicare Advantage plans and Medicare Part D prescription drug plans. Ratings take into account types of factors like:
- Customer support
- Complaints about the plan
- Member experience
- How many people choose to leave the plan
- Range of annual screenings and preventive services offered
- Speed with which appointments are obtained
- Chronic condition management
- Drug safety and drug pricing accuracy
The ratings do not take into account the cost of the plan itself, including premiums, co-insurance, and co-pays. Instead, the Medicare Star Ratings are meant to gauge overall satisfaction with a specific plan and the range of coverage, services, and support provided.
According to the U.S. Centers for Medicare & Medicaid Services, 72% of Medicare Advantage plans that include Part D prescription drug coverage have a four-star or higher rating for 2023.
How to Use Medicare Star Ratings
Medicare Star Ratings are meant to be a guide to Medicare plans, and you can view the ratings by logging in to your Medicare account. If you don’t yet have a Medicare account because you’re enrolling for the first time, you can still search for plans by ZIP code on the Medicare website.
You’ll be asked whether you receive any help with healthcare costs through Medicaid, Supplemental Security Income (SSI), the Medicare Savings Program, or Extra Help from Social Security. You can either answer “I don’t know” if you’re unsure, or “No” if you don’t receive those types of help. You’ll also have an opportunity to enter information for any prescription drugs that you’re currently taking.
Once you’ve entered those details, you’ll be shown a list of available plans in your area ranked in order of star rating. The highest-rated plans will be at the top. At this point, you’ll be able to review information for each plan, including:
- Monthly premiums
- Co-pays and co-insurance
- Plan benefits
- Drug coverage
You can compare plans against one another to see how they measure up. However, it’s important to keep in mind that Medicare Star Ratings are not intended to be the only thing you consider when choosing a plan.
It’s also important to consider your individual needs, preferred healthcare providers, and budget when selecting a Medicare Advantage plan. For example, if you’re debating whether to enroll in a Medicare health maintenance organization (HMO) or a Medicare preferred provider organization (PPO), you may want to ask questions like:
- Which doctors will I be able to see?
- Will I need to choose a primary care doctor?
- Is a referral required to see a specialist?
- What happens if I go out of network for care, and what will I pay?
You may want to revisit these questions each year to make sure that your current plan is still adequate. Fall open enrollment for Medicare starts in October and runs through December, but there’s a second open enrollment period for Medicare Advantage plans that goes from Jan. 1 to March 31. Planning ahead can help you make a more informed decision about whether to keep your current plan or switch to a new one.
During the Medicare Advantage open enrollment period, you can change to a new plan or drop your plan and return to Original Medicare coverage.
What are Medicare Star Ratings?
Medicare Star Ratings are ratings that measure various features of Medicare Advantage plans, including the quality of care provided, the range of benefits, and customer support. Medicare recipients can use Medicare Star Ratings as a guide when determining which Medicare Advantage plan or Part D plan to join.
How often do U.S. Centers for Medicare & Medicaid Services (CMS) Star Ratings come out?
The U.S. Centers for Medicare & Medicaid Services (CMS) updates Medicare Star Ratings each year. The new ratings generally come out in the fall ahead of the annual open enrollment period for Medicare.
What are the benefits of a five-star Medicare plan?
Generally speaking, a higher Medicare star rating indicates a higher level of satisfaction with the plan among people who are enrolled in it. Choosing a five-star plan may also afford enhanced benefits if the plan includes a wider range of features or services compared to a one-star plan. Star ratings do not, however, indicate what you’ll pay for a Medicare Advantage or Medicare Part D plan.
The Bottom Line
Choosing the right Medicare Advantage or Medicare Part D plan matters, as you don’t want to get stuck with a plan that doesn’t fit your needs or budget. Review Medicare Star Ratings ahead of the open enrollment period to help you to narrow down the list of plans in which you’re interested. You can then research the details of each plan on your short list to help you determine which one is the best choice for you.