Medicare star ratings (compiled by the government) help shoppers compare Medicare Advantage and Part D drug plans.
Comparison of Medicare Advantage Plans and Medicare Supplemental Drug Plans requires that you compare prescription drug coverage, copays, coinsurance costs, network of doctors, and service area. The plan’s star rating is another important metric to consider when making a decision.
What is the Medicare star rating?
As with most rating systems, the Medicare star rating helps rank plans from best (5 stars) to worst (1 star). The CMS generates ratings based on quality of care and customer satisfaction. You can find a plan’s rating with the Medicare Plan Finder.
This metric is subject to change every year as CMS reviews plans and updates ratings according to changes. Unless plans are new to market, ratings are published in October. In which case they won’t have ratings yet.
Medicare Advantage Plans
Medicare Advantage ratings are based on the following five categories:
- Members’ experience: What do they think about things such as the ease of scheduling appointments and seeing specialists?
- Performance of the plan: What is the history of complaints against the plan? Has it performed better or worse in the past? Is there a reason why members leave the plan?
- Customer service: Does the plan respond well to members’ appeals and requests?
- Maintaining good health: Does your family have access to screening tests, vaccines and checkups that will help you stay healthy?
- Chronic conditions: Does someone with a chronic condition get the tests and treatments they would normally be recommended?
Medicare Part D prescription drug plans
Medicare Part D plan ratings are based on the following four categories:
- Members’ experience with the plan: What do they rate it?
- Performance of the plan: What is the history of complaints against the plan? Has it performed better or worse in the past? Is there a reason why members leave the plan?
- Customer service: Does the plan respond well to members’ appeals and requests?
- Pricing and drug safety: Is the pricing information for the plan accurate? Members with certain medical conditions are prescribed drugs safely and appropriately?
Participating in a 5-star plan
You can enroll in a 5-star Medicare Advantage or Part D plan during the following enrollment periods:
- When you are new to Medicare, the Initial Enrollment Period (or when you enroll in Medicare).
- Open enrollment period (Oct. 15 – Dec. 7, each year).
- Medicare Advantage Open Enrollment Period (January 1st to March 31st each year, if already enrolled in an MA plan).
- Special Enrollment period, as described below.
You can change to a 5-star Medicare Advantage plan or Part D plan regardless of how your current plan is rated. This Special Enrollment Period, which exists only for this purpose, runs from December 8 through Nov 30. This can only be done once, and only if there is a 5-star plan in your area. Not all areas offer 5-star plans.
You’re eligible to receive a chance to enroll in a better plan if you are enrolled in a plan with a rating of less than 3 stars over three consecutive years.
