Medicare Star Ratings explained

Each year, Medicare reviews Medicare Advantage (Medicare Part C) and stand-alone Medicare prescription drug plans (Medicare Part D) and rates each one. The highest-performing plans earn 5 Stars; the lowest get 1 Star. Plans with a higher Star rating often offer added benefits and programs that lower-rated plans don’t—all at no additional cost to the member. 

When determining Star ratings, Medicare uses information from member satisfaction surveys, health plans and healthcare providers. 

How are Star ratings determined?

The rating system uses more than 40 different quality measures across multiple categories including:

• Customer service
• Member experience
• Staying healthy (screenings, tests and vaccines)
• Managing chronic conditions
• Drug safety and accuracy of drug pricing
• Getting appointments and care quickly
• Member complaints
• Members choosing to leave their plan

Here are just a few things Star ratings can show you.

How current members rated the plan

Did the Medicare plan provider make it easy for them to get the care they needed, when they needed it? Was customer service helpful and courteous on the phone?

How a plan performed based on industry standards

Were members able to take advantage of preventive care their plans provide, like flu shots or blood pressure screenings? Did the plan provide tools to help them manage chronic health issues like diabetes or rheumatoid arthritis?

How the plans you’re interested in compare to each other

Once you’ve narrowed down your plan choices, comparing their Star ratings may help you make a final decision.

The federal Medicare program provides financial rewards to insurers for highly rated plans. Insurers may use those rewards to reduce member premiums, copays, deductibles or to beef up a plan’s added benefits. So a 4- or 5-Star plan may include extras like dental, vision and hearing coverage. And that additional coverage may help lower your out-of-pocket healthcare costs.

In 2024, the typical shopper had 43 Medicare Advantage plans available to them.¹  That’s a lot to sort through! 

Here are just a few things to consider when choosing your Medicare coverage:

• Is your doctor in the plan’s network?
• Are the drugs you’re taking included in the list of covered drugs?
• Are there preferred cost-sharing pharmacies in your area?
• Is the plan affordable?    

Once you’ve answered the big questions and narrowed down your plan choices, you might want to consider the Star rating Medicare has assigned to each plan.