What Is a Medicare Star Rating and Why Does It Matter?

A Medicare star rating is a 1-to-5-star score assigned by the Centers for Medicare & Medicaid Services (CMS) that summarizes a plan's quality and member experience. Stars reflect dozens of measures including member satisfaction, preventive care rates, and customer service performance. Affordable Medicare Quote connects licensed agents with seniors reviewing these plan details.

What do star ratings measure?

Star ratings measure plan quality across five categories: staying healthy through screenings and tests, managing chronic conditions, member experience with the plan, member complaints and appeals, and health plan customer service.

Star ratings measure plan quality across five categories: staying healthy through screenings and tests, managing chronic conditions, member experience with the plan, member complaints and appeals, and health plan customer service. CMS collects performance data directly from plans and through surveys sent to members. Each category contains multiple individual measures—such as colorectal cancer screening rates, diabetes care, or call center wait times—and CMS weights them to produce an overall rating. Medicare Advantage plans and stand-alone Part D prescription drug plans both receive star ratings, published each fall for the upcoming contract year.

Where can you see a plan's rating?

You can see a plan's star rating on Medicare.gov's Plan Finder, in the printed Medicare & You handbook mailed to all beneficiaries, and on many plan marketing materials during Open Enrollment.

You can see a plan's star rating on Medicare.gov's Plan Finder, in the printed Medicare & You handbook mailed to all beneficiaries, and on many plan marketing materials during Open Enrollment. On Plan Finder, the rating appears next to each plan name as you filter and compare options. Plans with 5 stars earn a special enrollment period that allows beneficiaries to join or switch at any time during the year, not just during AEP or other limited windows. Plans with 4 or more stars may also offer rebates or extra benefits, so checking the rating can reveal added value.

Should ratings decide your choice?

Ratings should be one factor, but not the only factor, when choosing a plan. A 5-star plan that does not cover your doctors or prescriptions may serve you worse than a 3.5-star plan that does.

Ratings should be one factor, but not the only factor, when choosing a plan. A 5-star plan that does not cover your doctors or prescriptions may serve you worse than a 3.5-star plan that does. Start by confirming your physicians and hospitals are in-network and your drugs are on the formulary. Then compare monthly premiums, deductibles, copays, and maximum out-of-pocket limits. Use the star rating to compare plans that are otherwise similar in network and cost—higher-rated plans typically have better care coordination, fewer member complaints, and stronger customer service. Remember that star ratings reflect past performance; future service depends on many factors, including provider networks and plan changes for the new year.

How are high-rated plans different in practice?

High-rated plans often invest in care management programs, nurse help lines, medication adherence tracking, and faster customer service response times, all of which contribute to the scores CMS publishes.

High-rated plans often invest in care management programs, nurse help lines, medication adherence tracking, and faster customer service response times, all of which contribute to the scores CMS publishes. Members of 4- and 5-star plans report shorter hold times when calling the plan, clearer explanations of benefits, and more proactive outreach for preventive screenings. Some high-rated plans also coordinate with pharmacies to flag potential drug interactions or remind members to refill chronic medications. These operational differences can improve day-to-day experience, especially for beneficiaries managing multiple conditions or navigating complex drug regimens.

How Affordable Medicare Quote handles this

Affordable Medicare Quote delivers Medicare call back leads, live transfers, aged leads, and raw data to licensed agents who help beneficiaries compare plans—including star ratings—during Open Enrollment and year-round. Agents use these exclusive leads to walk seniors through cost, network, drug coverage, and quality measures in one conversation.

Affordable Medicare Quote delivers Medicare call back leads, live transfers, aged leads, and raw data to licensed agents who help beneficiaries compare plans—including star ratings—during Open Enrollment and year-round. Agents use these exclusive leads to walk seniors through cost, network, drug coverage, and quality measures in one conversation, ensuring the final choice fits the individual's health and budget. Because the leads are exclusive and filtered by licensed states, agents can spend time on thorough plan comparison without competing against other callers. Whether you need warm transfers during AEP peaks or aged inventory to fill floor capacity between seasons, the platform builds pipeline around your licensing and timing.

Frequently asked questions

Can a plan's star rating change every year?

Yes. CMS publishes new star ratings each October based on the prior year's performance data. A plan rated 4 stars one year may drop or rise the next year depending on member surveys, clinical outcomes, and complaint volumes.

Do Medigap supplements have star ratings?

No. Star ratings apply only to Medicare Advantage plans and stand-alone Part D prescription drug plans. Medigap policies are standardized by letter (Plan G, Plan N, etc.) and do not receive CMS quality scores.

Are 5-star plans always more expensive?

Not necessarily. Some 5-star plans charge $0 premium, while others have higher premiums. Compare the total cost—premium plus expected copays—rather than assuming higher quality means higher price.

How does CMS collect the data for star ratings?

CMS gathers data from plan administrative records (claims, enrollment files) and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey mailed to a sample of members each spring. The survey asks about doctor communication, getting care quickly, and customer service.

What happens if my current plan loses its 5-star rating?

You keep your coverage, but you lose the year-round enrollment privilege tied to 5-star plans. You will need to wait for Open Enrollment or another valid election period to switch, unless you qualify for a different special enrollment reason.

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