What Is the Medicare Star-Rating System?

The Medicare Star-Rating System is a method for consumers to evaluate and compare Part D drug plans and Medicare Advantage Plans, which vary greatly in terms of cost and coverage. Medicare reviews the performance of plans one a year and publishes new star ratings each fall.

Key Takeaways

  • Medicare Advantage Plans and Medicare Part D plans vary greatly in terms of coverage and costs.
  • The Medicare Star Rating System measures how well Medicare Advantage and Part D plans perform.
  • Medicare reviews plan performance every year and publishes new star ratings in the fall.

Understanding the Medicare Star-Rating System

Each January, Medicare Part D drug plans and Medicare Advantage Plans can change their coverage and costs for the new calendar year. Therefore, users of the plans should review their coverage and compare their plans with other available plans to ensure their coverage is optimal. The Medicare Star Rating System is a method that consumers can use to evaluate the different coverage options, making it easier to determine which policies are among either the best Medicare Advantage Plans or Part D plans currently available.

You can find a plan's star rating using Medicare's Plan Finder tool or by calling 1-800-MEDICARE.

How the Medicare Star Rating System Works

The Medicare Star Rating System measures the performance of plans based on several categories including quality of care and customer service. The categories are ranked between one to five stars, with five being the highest and one being the lowest. According to Medicare Interactive, Medicare Advantage Plans are rated on their performance in the following five different categories:

  1. Staying healthy: screenings, tests, and vaccines
  2. Managing chronic (long-term) conditions
  3. Plan responsiveness and care
  4. Member complaints, problems getting services, and choosing to leave the plan
  5. Health plan customer service

Part D plans are rated on how well they perform in the following four categories:

  1. Drug plan customer service
  2. Member complaints, problems getting services, and choosing to leave the plan
  3. Member experience with the drug plan
  4. Drug pricing and patient safety

Poor Performing Plans

A plan is found to be low-performing if it receives fewer than three stars from Medicare for three consecutive years. Medicare notifies individuals if their plan has been found to be low-performing. Enrollees can change plans during specific times or during Special Enrollment Periods (SEP), which are times outside normal enrollment periods that are triggered by specific circumstances.

Plan Enrollment

In general, you can change your plan or enroll in a new one only during a Special Enrollment Period. You can use an SEP to join or switch to a five-star Medicare Advantage or Part D plan. However, a SEP can only be used once a year. The SEP begins Dec. 8 of the year before the plan is considered a five-star plan (ratings comes out in October). It lasts through Nov. 30 of the year the plan is deemed a five-star plan. Enrollments in December are effective Jan. 1, and enrollments from January to November are effective the month following the enrollment request.