The Centers for Medicare and Medicaid Services (CMS) created a star rating system to help Medicare-eligible individuals and caregivers quickly compare the performance and quality of Medicare Advantage plans and Part D prescription drug plans. This rating system helps Medicare shoppers and caregivers evaluate different plans – an important factor for someone enrolling for the first time or considering a change during the Medicare Annual Enrollment Period.
How are Medicare plans rated?
CMS rates Medicare Advantage and Part D plans annually, using a scale from one to five, with more stars equating to better performance and quality. A five-star rating is the highest a Medicare Advantage or Part D plan can receive, and half-ratings also exist (1.5, 2.5, 3.5, 4.5).
Here’s what the star ratings mean:
- 5-star rating: excellent performance
- 4-star rating: above-average performance
- 3-star rating: average performance
- 2-star rating: below-average performance
- 1-star rating: poor performance
Star ratings are released by CMS around early October, just before the Medicare Annual Enrollment Period begins. CMS evaluates and scores three types of Medicare plans each year.
- Medicare Advantage plans with prescription drug coverage (MA-PD)
- Medicare Advantage plans without prescription drug coverage (MA only)
- Standalone Part D prescription drug plans (PDP)
Depending on the type of plan being evaluated, CMS uses anywhere from 12 to 38 quality and performance measures.
Why is the Medicare star rating important?
A Medicare plan’s star rating is important because it can help you when comparing different plans. You should not use a star rating as the only factor when making a final decision though. Some plans that have fewer than five stars may actually be a better fit for you. Use the Medicare star rating as just a single factor of evaluation. Your health, lifestyle, and financial needs should always be the final determining factors, and it’s important to read the details of each plan.
What determines a Medicare Advantage or Part D plan’s star rating?
Below are some examples of quality and performance measures CMS may use to determine the star rating for a Medicare Advantage or Part D plan. You’ll notice some are more about the plan and plan provider, while others are specific to a health care service or item.
Quality and performance measures related to the plan or plan provider:
- Customer service
- Care coordination
- Complaints about the plan
- Getting needed care
- Rating of health care quality
- Members choosing to leave the plan
- Getting appointments and care quickly
Quality and performance measures related to health services:
- Breast cancer screening
- Diabetes care
- Rheumatoid arthritis management
- Annual flu vaccine
- Monitoring physical activity
- Colorectal cancer screening
- Getting needed prescription drugs
- Medication adherence for cholesterol or diabetes medication
More information about the Medicare plan star ratings for 2022
Here are some statistics from CMS about the 2022 star ratings:1
- Approximately 68% of Medicare Advantage plans with included prescription drug coverage will have an overall rating of four stars or more
- The number of plans with at least four stars has increased by 49% since 2021
- Approximately 90% of people currently enrolled in Medicare Advantage plans with included prescription drug coverage are enrolled in a plan that has at least a four-star rating
- Adjustments were made for the 2022 star ratings due to the possible impact of COVID-19
It’s important to note that the 2022 star ratings may decrease for 2023 based on the potential removal of the COVID-19 impact adjustments.
How do I find my Medicare plan’s rating?
To find a Medicare plan’s star rating, use the Medicare.gov plan finder tool, where you can simultaneously compare star ratings, as well as plan benefits and costs.
Many plan providers will indicate if a plan has a five-star rating, but you can always directly ask your Medicare plan provider by contacting them via phone or online.
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