A lot of people think all Medicare plans are the same. But that’s not the case. An easy way to tell which plans are top performers is to check their Medicare Star Rating.

Each year, the Centers for Medicare and Medicaid Services (CMS) measures how well Medicare plans perform. The scale that’s used is known as the Star Rating System. CMS gathers information from member satisfaction surveys, plans, and health care providers to give an overall performance rating for plans. Ratings range from one to five stars, with five being the highest score a plan can get.

5 Stars is the highest rating

Typically, only a handful of plans in the nation get a 5-Star rating each year. CMS considers any plan with a 4-star rating or more to be an above average plan. However, if a plan gets a 5-star rating, it is considered excellent. This means you’ll get a plan that excels at keeping members healthy and has better customer service. So, when you’re looking for a plan, be sure to check if there are any 5-star plans available in your area.

On the other end of the scale, if CMS gives a plan fewer than three stars for three years in a row, that plan will be flagged as low-performing. If you’re enrolled in a low-performing plan, CMS will contact you directly so you can start considering other options if you want to.

Medicare plans eligible for star ratings include Medicare Advantage, Medicare Cost, and Medicare Part D prescription drug plans.

Medicare Supplement (Medigap) plans aren’t eligible for star ratings.

What is the 5-star Special Enrollment Period?

If you want to switch from your current Medicare plan to a Medicare plan with a 5-star rating, you can take advantage of a Medicare Special Enrollment Period (SEP) to join or switch to a qualifying plan – meaning a Medicare Advantage, Medicare Cost, or a Medicare Part D prescription drug plan – in your area.

This 5-star Special Enrollment Period begins December 8 and lasts through November 30:

  • Enrollments in December are effective January 1
  • Enrollments from January to November are effective the month following the enrollment request
  • You may only use this SEP once between December 8 and November 30

What are CMS star ratings based on?

Medicare plans that provide health coverage – like Medicare Advantage and Medicare Cost plans – are given an overall rating based on their performance in 5 categories.

  1. Staying Healthy: How often members get, and have access to preventive services like screenings, physical exams and vaccinations. This reflects how well the plan keeps members healthy through checkup reminders and general communication.
  2. Managing Chronic Conditions: How often members get recommended tests and treatments for long-term health issues. This reflects how well the plan helps members get these recommended tests and treatments. For example, plans may offer different programs and resources to help members manage certain conditions like diabetes, high blood pressure, arthritis and osteoporosis.
  3. Member Experience: How members rate their experience with the plan, including getting care from their doctor and getting prescription meds. 
  4. Member Complaints and Performance: How often members found problems with the plan. It also measures how much the plan’s performance improved year over year.
  5. Customer Service: How often the plan had foreign language interpreters and TTY services available. This category also includes processing appeals and new enrollments in a timely manner.

Medicare drug plans – Part D prescription and Medicare Advantage plans that include drug coverage – are given an overall rating based on their performance in Member Experience, Member Complaints and Performance, and the Customer Service categories from above, with one addition:

  1. Drug Safety and Accuracy of Drug Pricing: How often members are prescribed medicine in a way that’s safe and recommended for their condition and how accurate the plan’s pricing information is.

For more information on the 5-star rating criteria Medicare considers when rating its plans, visit Medicare.gov. You can also look up specific plan Star Ratings using the Medicare Plan Finder Tool.

When are Medicare Star Ratings updated?

Every fall, CMS releases the Star Ratings for the upcoming plan year. For example, plan ratings for 2022 will be available in October 2021. Star Ratings are calculated each year and may change from one year to the next.

If you’re enrolled in a Medicare plan, you should check your plan’s Star Rating every fall. Then you can make an informed decision about whether to stay on the plan or switch to a more highly rated plan.