What Is the Medicare Star Rating System and How Does It Work?

Consumers can use the Medicare Star Rating System to review and compare Part D prescription plans and Medicare Advantage Plans, which differ substantially in terms of cost and coverage. Every year, Medicare evaluates plans’ performance and publishes new star ratings in the fall.


Why do the coverage and pricing of Medicare Advantage Plans and Medicare Part D Plans differ significantly?

  • The Medicare Star Rating System assesses the quality of Medicare Advantage and Part D plans.
  • Medicare evaluates plan performance once a year and issues new star ratings in the fall.

The Medicare Star Rating System: What It Is and Isn’t.

Medicare Part D prescription and Medicare Advantage plans can adjust their coverage and costs in January for the coming calendar year. As a result, users of the plans should examine their coverage and compare their plans to alternative options to ensure that they have the best coverage. Consumers can utilize the Medicare Star Rating System to compare different coverage alternatives, making it easy to figure out which policies are among the top Medicare Advantage Plans or Part D plans currently available.

What Is the Medicare Star Rating System, and How Does It Work?

The Medicare Star Rating System assesses a plan’s performance in numerous areas, including care quality and customer service. The categories are rated on a scale of one to five stars, with five being the best and one being the worst. Medicare Advantage Plans are graded based on their performance in five major categories, according to Medicare Interactive:

  • Maintaining good health through screenings, exams, and vaccinations.
  • Managing long-term (chronic) conditions.
  • Make a plan for responsiveness and care.
  • Complaints from members, service issues, and the option to leave the plan.
  • Customer service for health insurance plans.

Part D plans are evaluated based on how well they perform in the four criteria below:

  • Customer service for drug plans.
  • Member grievances, service issues, and the decision to leave the plan.
  • Drug plan experience of members.
  • Patient safety and drug price.

Plans That Aren’t Working.

If a plan obtains less than three stars from Medicare for three years, it is low-performing. Medicare will notify a person if their plan is underperforming. Enrollees can switch plans at certain times or during Special Enrollment Periods (SEPs), which are times outside of usual enrollment periods, and any specific situations can be the reason.

Enrollment in a Plan.

You may modify your plan or enroll in a new one during a Special Enrollment Period. You can join or switch to a five-star Medicare Advantage or Part D plan using a SEP. On the other hand, you can use SEP once every year. The SEP begins on December 8th of the year preceding the plan’s designation as a five-star plan (ratings come out in October). It is a five-star plan that lasts until November 30th of the current year. Enrollments in December take effect on January 1st, while enrollments in January through November take effect the next month.

Learn more about medicare on our website medicareleads.com.