Understanding Medicare Star Ratings: Why They Matter for Your Plan Choice
CMS rates every Medicare Advantage and Part D plan on a 1-to-5 scale. Here's what those stars actually mean.
Every fall, CMS publishes star ratings for every Medicare Advantage and Part D plan in the country. A 5-star plan is a signal of quality — but it also unlocks a benefit most people don't know about: the ability to switch plans at any time of year.
What the stars mean
Top-performing plan. Unlocks a 5-Star Special Enrollment Period — you can switch to it any time of year.
Above-average performance. A solid choice, but no special enrollment privileges.
Average performance. Meets CMS standards but doesn't stand out.
Plan has significant issues. Consider switching if this is your current plan.
How CMS calculates the ratings
Star ratings aren't marketing — they're calculated by CMS from dozens of objective measures across five categories:
- Staying healthy: screenings, vaccines, and preventive care rates
- Managing chronic conditions: diabetes, heart disease, COPD monitoring
- Member experience: satisfaction surveys, complaints, and appeals
- Customer service: call center performance, timeliness
- Drug plan performance: formulary accuracy, medication adherence
The 5-star Special Enrollment Period
Here's the part most people miss: if a 5-star Medicare Advantage or Part D plan is available in your area, you can switch to it at any time during the year — not just during AEP.
This is called the 5-Star Special Enrollment Period. You can use it once per year, and you can switch from your current MA plan to a 5-star MA plan, or from your current Part D plan to a 5-star Part D plan. You can't use it to go from a Medicare Advantage plan back to Original Medicare.
Star ratings are one factor — not the only one
A 5-star plan that doesn't cover your prescriptions or include your doctors isn't the right plan for you. Use star ratings alongside cost, network, and drug coverage. A 3.5-star plan with your doctors, your drugs, and lower out-of-pocket costs may be the better choice.
Find the right plan — stars and all
A licensed Health Plus One agent can compare star ratings, costs, networks, and drug coverage side by side.
Not sure where you stand? Take a quick quiz
Keep reading
5 Things to Review Before Medicare's AEP
A pre-AEP checklist: costs, doctors, drugs, benefits, and star ratings.
Read articleMedicareHow to Switch Medicare Plans During AEP
A step-by-step guide to switching plans during the Annual Enrollment Period.
Read articleMedicareWill Your Doctors Still Be In-Network?
How to verify your providers before AEP opens.
Read articleStay ahead of the curve
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This article is for educational purposes only and is not medical, legal, or financial advice. Star ratings are published by CMS and subject to change annually. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, call 1-800-MEDICARE, or contact your local State Health Insurance Assistance Program (SHIP) for all available options.
Health Plus One Agency is not connected with or endorsed by the United States government or the federal Medicare program.