Medicare Advantage Star Ratings Explained: What They Mean for You

Every fall, the Centers for Medicare & Medicaid Services (CMS) releases Medicare Advantage star ratings for every plan in the country. These ratings — from 1 to 5 stars — are one of the most useful tools for comparing plan quality, yet many beneficiaries don’t know they exist or how to use them.

Here’s a complete breakdown of Medicare Advantage star ratings: what they measure, what they don’t, and how to use them when choosing a plan.

What Are Medicare Advantage Star Ratings?

Medicare Advantage star ratings are an annual quality and performance score assigned to Medicare Advantage plans (and Part D plans) by CMS. Ratings range from 1 star (worst) to 5 stars (best), in half-star increments.

Plans rated 4 stars or above are considered “high quality” and receive bonus payments from Medicare — which insurers typically reinvest into lower premiums or enhanced benefits. Plans with 5 stars receive the highest bonus and have a special enrollment privilege (more on that below).

What Do Star Ratings Measure?

Star ratings evaluate plans across dozens of measures, grouped into major categories:

For Health Plans (Medicare Advantage):

• Staying healthy: Screenings, tests, and vaccines (flu shots, mammograms, colorectal screenings, etc.)
• Managing chronic conditions: How well members with diabetes, cardiovascular disease, and other conditions get appropriate care and medication
• Plan responsiveness and care: Member satisfaction scores, how quickly the plan responds to complaints, how it handles appeals
• Member complaints and changes in performance: Number of complaints filed with Medicare, stability of the plan’s ratings over time
• Customer service: Call center responsiveness, accuracy of information provided

For Drug Plans (Part D, scored separately):

• Drug safety and accuracy
• Member experience with the plan
• Medication adherence (members taking medications as prescribed)
• Formulary management

How Are Star Ratings Calculated?

CMS collects data from multiple sources:

• HEDIS (Healthcare Effectiveness Data and Information Set): Standardized measures of preventive care and chronic disease management
• CAHPS (Consumer Assessment of Healthcare Providers and Systems): Member surveys about experiences with care and customer service
• HOS (Health Outcomes Survey): Member health status over time
• Administrative data: Appeals, complaints, enrollment/disenrollment patterns

Measures are weighted differently — consumer experience and outcomes tend to carry more weight than administrative measures. CMS updates the weighting methodology periodically.

What Star Ratings Don’t Tell You

Star ratings are one important data point, but they don’t capture everything:

• Network quality: A plan can have a 5-star rating but not include your preferred doctors or hospital.
• Cost: A lower-rated plan might have lower out-of-pocket costs for your specific health needs.
• Formulary fit: Star ratings don’t tell you if your specific medications are covered.
• Local variation: Plan quality can vary significantly between regions even within the same insurer.

A 4-star plan with your doctors in-network and your medications covered at Tier 1 may be better for you than a 5-star plan where you’d be out-of-network for everything.

The 5-Star Special Enrollment Benefit

One practical advantage of 5-star plans: CMS grants a Special Enrollment Period (SEP) allowing any eligible Medicare beneficiary to switch to a 5-star plan once per year, outside of the Annual Enrollment Period (October 15–December 7).

This SEP runs from December 8 through November 30 of the following year — essentially year-round. If you’re in an underperforming plan and a 5-star plan is available in your area, you can switch without waiting for AEP.

How Plans Earn High Star Ratings

High-performing plans generally:

• Proactively connect members with preventive screenings
• Use care coordinators for chronic condition management
• Have robust customer service operations
• Respond quickly and fairly to appeals and grievances
• Actively work to close gaps in care

Plans that earn 4+ stars consistently tend to be better partners in managing your long-term health — not just insurers who pay claims.

How to Check a Plan’s Star Rating

You can find star ratings for any Medicare Advantage or Part D plan through:

• Medicare.gov/plan-compare: Star ratings are displayed alongside plan costs when searching for plans in your area
• Medicare & You handbook: CMS mails this annually to beneficiaries
• Licensed Medicare brokers: Can advise on quality and value simultaneously

2026 Star Rating Landscape

In recent years, CMS has tightened quality thresholds, resulting in fewer plans achieving 4 and 5 stars compared to the peak years of 2022-2023. Many large insurers saw ratings drop due to stricter CMS methodology. This means it’s more important than ever to check current ratings — don’t assume a plan’s historical reputation reflects its current quality score.

Bottom Line

Medicare Advantage star ratings are a valuable quality signal — but just one piece of the puzzle. Use them alongside cost comparison, network verification, and formulary review to make a well-rounded decision. Always prioritize plans rated 3.5 stars or above, and strongly consider 4+ star plans if they meet your other needs.