Medicare Star-Rating System: What It Is, How It Works

Anthony Battle is a CERTIFIED FINANCIAL PLANNER™ professional, holding several advanced designations including Chartered Financial Consultant™, Chartered Life Underwriter™, Accredited Financial Counselor™, Retirement Income Certified Professional™, and Certified Retirement Counselor.

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 in cost and coverage. Medicare reviews plan performance annually and publishes new star ratings each fall.

Key Takeaways

• Medicare Advantage Plans and Medicare Part D plans vary in coverage and costs.
• The Medicare Star Rating System measures plan performance.
• Medicare reviews plan performance annually and publishes new star ratings in the fall.

Understanding the Medicare Star Rating System

Each January, Part D drug plans and Medicare Advantage Plans can change coverage and costs for the new calendar year. Users should review their coverage and compare plans to ensure they have optimal coverage. The Medicare Star Rating System helps evaluate different coverage options and determine the best plans available.

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 plan performance based on categories such as quality of care and customer service. Ratings range from one to five stars, with five being the highest and one being the lowest. Medicare Advantage Plans are rated on five 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 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 considered low-performing if it receives fewer than three stars from Medicare for three consecutive years. Medicare notifies individuals if their plan is low-performing, and they can change plans during Special Enrollment Periods (SEPs) triggered by specific circumstances.

Plan Enrollment

In general, you can change or enroll in a new plan 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, starting in December of the previous year. Enrollments in December are effective in January, while enrollments from January to November are effective the following month.

How do I see the star ratings for Medicare plans?

The Medicare Star Rating System is based on quality of care and customer service. You can find each plan’s rating using Medicare’s Plan Finder tool or by calling 1-800-MEDICARE.

Can I change my Medicare plan if it isn’t good?

Yes, if your Medicare plan scores below three stars for three consecutive years, it is considered low-performing. If you want to change your plan, there are Special Enrollment Periods (SEPs) each year.

What is the Medicare Star-Rating System based on?

Each year, Medicare looks at member satisfaction surveys and healthcare provider feedback to determine the overall rating for each plan. To receive five stars, a plan must have excellent customer service, pricing, turnover rate, health results, and patient and healthcare provider satisfaction.

The Bottom Line

Medicare Advantage Plans and Medicare Part D plans vary in coverage and costs. The Medicare Star Rating System measures plan performance. Medicare reviews plan performance annually and publishes new star ratings in the fall. You can find each plan’s rating using Medicare’s Plan Finder tool or by calling 1-800-MEDICARE.