What are Medicare Star Ratings and how do I use them?

Medicare Star Ratings are CMS's quality scores for Medicare Advantage and Part D plans, ranging from 1 star (poor) to 5 stars (excellent), updated annually each fall. They measure how well plans deliver care, control costs, and serve members. Star Ratings affect how plans market themselves, what they pay providers, and your right to switch plans during the year.

The five-star scale:

• ⭐ 1 star: Poor performance
• ⭐⭐ 2 stars: Below average
• ⭐⭐⭐ 3 stars: Average
• ⭐⭐⭐⭐ 4 stars: Above average
• ⭐⭐⭐⭐⭐ 5 stars: Excellent

For 2026 plans (rated based on 2024 data, released October 2025):
- About 7% of Medicare Advantage with Part D (MAPD) plans received 5 stars
- About 32% received 4 or 4.5 stars
- About 50% received 3.5 stars
- About 11% received 3 stars or fewer

What goes into the rating:

Medicare Advantage plans are rated on up to 40+ measures across:

1. Staying healthy (preventive care):
- Breast cancer screening, colorectal cancer screening, annual flu vaccine, diabetes care, blood pressure control

2. Managing chronic conditions:
- Diabetes care (A1c testing, eye exams), heart disease care, follow-up after hospital stays for mental illness

3. Member experience:
- Customer service, getting needed care, getting appointments quickly

4. Member complaints, problems getting service:
- Complaints per 1,000 members, members leaving the plan, problems with foreign language services

5. Customer service:
- Timely processing of appointments, accurate plan information, member call wait times

Part D plans (standalone) are rated on:
- Drug pricing and patient safety
- Member experience with the drug plan
- Member complaints
- Customer service

Why Star Ratings matter to YOU:

1. The 5-star Special Enrollment Period (SEP)

If there's a 5-star MA or Part D plan available in your area, you can switch to it ONCE between December 8 and November 30 of the following year — outside of the standard AEP/OEP windows. Most members don't know this.

For example: 5-star plan exists in your county. You're currently in a 3.5-star plan. You can switch in March, June, October — you don't have to wait for AEP.

2. Quality bonus payments to plans

MA plans rated 4+ stars receive bonus payments from CMS that they can use to:
- Reduce premiums
- Add benefits (dental, vision, transportation, OTC allowance)
- Lower copays
- Extend dental annual maximums

This is why 4+ star plans often offer richer benefits than 3-star plans at the same premium level. The CMS bonus money pays for the extras.

3. Regulatory consequences for low-star plans

Plans rated below 3 stars for 3 consecutive years can be terminated by CMS. Plans rated below 4 stars cannot market in certain ways (e.g., can't claim "5-star quality" benefits).

4. Enrollment trends

Higher-star plans grow membership. Lower-star plans shrink. As of 2026, about 88% of MA enrollees are in 4+ star plans.

5. Network and provider relationships

4+ star plans typically have more provider relationships, better contracted rates, and more in-network specialist availability.

How to find a plan's Star Rating:

• Medicare.gov Plan Finder: Star Rating displayed prominently for every plan
• Plan's Annual Notice of Change (ANOC): Each fall, your current plan sends its Star Rating for the next year
• CMS website (cms.gov): Public spreadsheets with all ratings and component scores
• Carrier marketing materials: Plans usually highlight their stars if 4+

Star Rating cautions:

1. Star Ratings reflect HISTORICAL data. The 2026 rating is based on 2024 performance. A plan that got 4 stars in 2026 may be 3.5 stars in 2027 if performance dropped.

2. Aggregate Star Ratings hide variation. A plan with 4.5 stars overall might be 5 stars on customer service but 3 stars on diabetes care. If you have diabetes, look at the diabetes-specific component score.

3. Star Ratings don't reflect YOUR specific experience. A 5-star plan in your county might still have a poor specialist network for your specific condition. Check the network and formulary for your specific needs.

4. Geographic variation. A national insurer (UnitedHealthcare, Humana, Aetna) often has different Star Ratings for different plan products in different markets. The UHC plan in Florida may be 4 stars; the same UHC product in Texas may be 3.5 stars.

5. Manipulation concerns. Plans actively work to improve Star Ratings — sometimes through legitimate quality improvements, sometimes through measure-specific gaming (e.g., aggressive call-center scripting that boosts customer service scores).

Strategy for using Star Ratings in plan choice:

1. Filter to 4+ star plans first — covers 88% of available plans, eliminates the bottom tier.

1. Check the specific Star Rating components most relevant to YOU:

1. Don't pick a 5-star plan over a 4-star plan if the 4-star plan fits better on doctor network, formulary, or premium. Star Rating is one factor among many.

1. Use the 5-star SEP if it benefits you. Most members miss this. If a 5-star plan is available and a better fit, switch outside of AEP.

1. Don't ignore low-star plans entirely — sometimes a 3-star plan has the best network or formulary for your specific needs. Star Rating reflects population-average outcomes, not your individual experience.

For Original Medicare + Medigap:

Star Ratings don't apply directly to Original Medicare or Medigap (those have no networks to rate). But Star Ratings DO apply to Part D drug plans you'd add to Original Medicare. Choose 4+ star Part D when possible.

Star Ratings as a brokerage filter:

Good independent brokerages should:
- Default to recommending 4+ star plans
- Justify any recommendation of a 3-star plan
- Disclose Star Rating with every recommendation
- Discuss the 5-star SEP if applicable

What to do next: Call (866) 534-1886. We compare every plan in your county by Star Rating + the components most relevant to YOUR conditions, AND screen for 5-star SEPs in your area. Free.