En español | The Centers for Medicare & Medicaid Services (CMS) assesses Part D prescription drug plans and Medicare Advantage plans every year based on several quality measures. CMS gives each plan a star rating from five stars (excellent) to one star (poor).
Based on a lot of data. To create the ratings Medicare looks at surveys of people enrolled in the plans, complaints filed against plans, Medicare investigators’ spot-checks, reliability of pricing information and other factors. The plans receive an overall star rating plus separate star ratings in myriad categories:
- Part D prescription plans are rated on up to 12 quality measures, such as customer service and member experience.
- Medicare Advantage plans with drug coverage are rated on those 12 categories and up to 28 additional performance measures, such as the percentage of eligible participants who get certain health screenings and how well the plan cares for people with certain chronic conditions.
- Medicare Advantage plans without drug coverage are rated only on those 28 performance measures.
Why look up a plan’s star ratings? If you want to know how one plan stacks up against another in customer service or managing care for a chronic condition you may have, star ratings are a good source. You can look up a plan’s rating in each category, in addition to its overall star ratings, when using the Medicare Plan Finder to compare Part D or Medicare Advantage plans available in your area.
What do Medicare star ratings measure?
Medicare Advantage plans’ star ratings are based on five major categories:
5. Customer service. The timeliness of a plan’s decision about appeals, the fairness of those decisions based on an independent review, and availability of services in other languages or for the hearing-impaired.
Medicare Part D plans. Both stand-alone plans and Medicare Advantage plans with prescription drug coverage have star ratings based on the following categories:
1. Customer service. The availability of foreign language interpreters and teletype services for callers who are deaf or hard of hearing.
2. Member complaints. The percentage of members who choose to leave the plan.
3. Member experience. Members rate the drug plan and the ease of getting prescriptions filled.
4. Drug safety and correct pricing. The accuracy of pricing information on a plan’s website, the percentage of members who take certain medications as directed for chronic conditions, and the number of members who had a health professional help them understand and manage their medications.
Where do I find a plan’s star ratings?
To find star ratings for plans in your area, go to the Medicare Plan Finder, type in your information, filter the results by Star Ratings, choose the number of stars and click the Apply button. You can filter for five-star plans in your area. You’ll find a list of plans with that rating or see a notice that no plans with that rating are available in your area.
Plans with a five-star rating are marked with a special five-star icon underneath their plan names. You also can find five-star plans by calling 800-MEDICARE (800-633-4227) or contacting your State Health Insurance Assistance Program (SHIP).
To check star ratings for any Medicare Advantage plan: Click Plan Details | What you’ll pay | Star Ratings.
Courtesy Medicare.gov
To see a Medicare Advantage plan’s detailed rating, click on the + Health plan star rating and you’ll see the list of five categories, each with its own star ratings. Click the plus sign (+) for a category to see star ratings for subcategories.
Courtesy Medicare.gov
For Part D plans: Click Plan Details | What you’ll pay | Star Ratings | + Drug plan star rating and you’ll see the list of four categories, also each with its own star ratings. Click the plus sign (+) for subcategories.
Do star ratings affect when I can enroll in a plan?
Yes. Even though you can usually switch to any Medicare Advantage or Part D prescription plan during open enrollment Oct. 15 to Dec. 7 each year, you have an extra opportunity to make a change if a plan in your area has an overall five-star rating. You can make a onetime switch into that plan any time during the year, called a five-star special enrollment period. Coverage begins the first day of the month after the plan receives your request.
If your plan received fewer than three stars for the past three years, you’ll have about 14 months to change to a plan with a better rating. Usually near the end of October, Medicare notifies members of those plans that they can switch at any time until the end of the following year.
Keep in mind
A plan’s star ratings are just one factor to consider when choosing a Part D or Medicare Advantage plan.
Be sure to compare the costs and coverage for your medications. For Medicare Advantage plans, also find out about coverage for your health care needs and whether your doctors and preferred hospitals are in the plan’s network.
Published December 7, 2022
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