When you compare Medicare plans, you may see a rating shown as one to five stars. These are called Medicare Star Ratings. They are designed to help you compare the quality and performance of Medicare Advantage and Medicare Part D prescription drug plans.
Star Ratings can be useful, but they are only one part of choosing coverage. A highly rated plan may still not include your doctors, cover your medications the way you need, or fit your budget. Looking at the full picture can help you make a more confident choice.
What are Medicare Star Ratings?
Medicare uses a one-to-five-star system to rate Medicare Advantage plans and stand-alone Part D drug plans. A plan with five stars is considered the highest-rated option, while one star is the lowest rating.
Ratings are generally updated each year. They are based on information from plan members, health care providers, and the plans themselves. Medicare may also use data about customer service, member complaints, health care outcomes, and how well a plan manages certain services.
Not every plan has a Star Rating. For example, a plan that is new to an area may not have been operating long enough to receive one. That does not automatically mean the plan is poor. It simply means there may not yet be enough information available to rate it.
What do Medicare Star Ratings measure?
Star Ratings look at several areas of plan performance. The exact measures may vary depending on whether you are reviewing a Medicare Advantage plan or a Part D drug plan.
For Medicare Advantage plans, ratings may include:
- How members rate their overall health plan experience
- How easy it is to get appointments and needed care
- Customer service and how the plan handles complaints
- Preventive care, such as screenings and vaccinations
- How the plan helps manage long-term conditions, such as diabetes or high blood pressure
For stand-alone Part D prescription drug plans, ratings may include:
- How well the plan handles member appeals and complaints
- Customer service experience
- Medication safety programs
- Whether members are able to get prescriptions when needed
- Accuracy and timeliness of information provided by the plan
These measures can give you a general sense of how a plan performs. Still, they may not tell you exactly what your own experience will be.
How should you use Star Ratings when comparing plans?
It can be helpful to view Star Ratings as a starting point rather than a final answer. If two plans offer similar doctor access, drug coverage, and costs, a stronger rating may help you narrow your choices.
However, a plan with fewer stars may sometimes fit your personal needs better. For example, it may include your preferred doctors, have a stronger drug formulary for your prescriptions, or offer benefits that matter to you. A formulary is the plan's list of covered medications.
When comparing Medicare Advantage or Part D plans, consider these items along with the Star Rating:
- Whether your doctors, hospitals, and pharmacies are in the plan's network
- Whether your prescription drugs are covered and what coverage rules may apply
- Your monthly premium, deductible, copays, and other out-of-pocket costs
- The plan's service area and availability where you live
- Extra benefits, if any, such as dental, vision, hearing, fitness, or transportation services
Benefits, provider networks, drug coverage, and premiums can vary by plan, carrier, county, and state. A plan that works well for a neighbor may not be the best match for you.
Do Medicare Supplement plans have Star Ratings?
No. Medicare Supplement insurance, also called Medigap, does not use the Medicare Star Rating system.
Medigap plans work differently from Medicare Advantage and Part D plans. A Medicare Supplement plan helps pay certain out-of-pocket costs left by Original Medicare, such as deductibles, coinsurance, and copayments. It does not generally include outpatient prescription drug coverage, so many people with Medigap also consider a separate Part D plan.
Medigap plans are standardized in most states. For example, a Plan G from one insurance company generally offers the same basic Medicare-covered benefits as Plan G from another company in the same state. The premium, underwriting rules, customer service, rate history, and available household discounts may differ by carrier and location.
Because Star Ratings do not apply to Medigap, it can be wise to compare carriers carefully rather than relying on a single rating. Your enrollment timing matters, too. Outside certain protected enrollment periods, an insurance company may ask health questions before accepting an application.
Can a five-star plan be the right choice for everyone?
Not necessarily. A five-star rating can be a positive sign, but it does not guarantee that a plan will meet every person's needs. Networks can change. Drug formularies can change. Your health needs, prescriptions, and preferred providers may also change over time.
It is also important to understand the type of coverage you are considering. Medicare Advantage plans combine Medicare-covered services into one private plan and may include extra benefits. These plans often use provider networks and may have rules for referrals or prior authorization. Original Medicare with a Medicare Supplement plan offers a different structure, with broad access to providers who accept Medicare, but it typically requires separate Part D coverage for prescriptions.
Neither approach is automatically best for everyone. The right choice often depends on how you prefer to receive care, the doctors you use, your medication needs, travel habits, and comfort with out-of-pocket costs.
When should you check plan ratings?
It is a good idea to review Star Ratings whenever you are shopping for a Medicare Advantage or Part D plan. Many people do this during the Medicare Annual Enrollment Period, when they can review coverage for the following year.
You may also want to check ratings if your current plan sends an Annual Notice of Change showing that its benefits, provider network, drug coverage, or costs are changing. Even if you are happy with your plan today, reviewing it each year can help you avoid surprises.
Medicare Star Ratings can be a helpful comparison tool, but your personal coverage needs should remain at the center of your decision. If you would like free, no-pressure help comparing Medicare Supplement options or understanding how they fit with Part D coverage, reach out to Eric for guidance based on your situation.