All Medicare Advantage plans (Medicare Part C) and Medicare prescription drug plans (Medicare Part D) are assigned an annual star rating by the Centers for Medicare & Medicaid Services (CMS).1
A five-star rating system is used, with one star being given to the lowest-rated plans, and five stars being reserved for only the highest-rated plans. Star Ratings are calculated each year and may change from one year to the next.
To enroll in a 5-star Medicare Advantage plan, you can call TTY Users: 711 to speak with a licensed insurance agent about 5-star plans that may be available where you live.
Let’s take a look at five-star Medicare Advantage plans, including what makes them so valuable and the steps you can take to enroll in one.
Medicare determines which Medicare Advantage plans are highest rated based on information gathered from health care providers who accept the plan, plan member satisfaction surveys, positive health outcomes, customer service and more.
A 5-star plan is considered an excellent plan, and any plan rated 4 stars or higher is considered "top rated." 1-star plans are the lowest-rated plans, and these plans typically earn their low rating due to poor plan performance, low customer satisfaction and bad customer service.
The star rating system for Medicare Advantage plans is as follows:
The rating system uses five key metrics in its assessment of a Medicare Advantage plan:
In addition to an overall rating, each Medicare Advantage plan is rated in each of the five individual categories. Medicare Star Ratings are released in October of each year for the upcoming calendar year.
If a plan receives a rating of fewer than three stars for three consecutive years, it becomes flagged by the CMS as a low-performing plan. If the plan continues to underperform, Medicare may remove the plan entirely from the marketplace.
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Because the availability of Medicare Advantage plans varies from one location to the next, you may want to call TTY Users: 711 to speak with a licensed insurance agent.
An agent can go over the plan options available in your area and identify which ones have received a five-star rating.
An agent can also discuss the costs, terms, coverage and other details about available plans, which can be helpful for you to know prior to enrolling. And if you choose to enroll, the agent can walk you through the steps and help you complete the process.
If you are enrolled in a Medicare Advantage plan rated lower than five stars but you find a five-star plan in your area, you may be able to switch to the five-star plan at any time between December 8 and November 30 of the following year. This is called the five-star Special Enrollment Period.
There are certain Medicare enrollment periods during which you may enroll in a five-star Medicare Advantage plan.
You can sign up for a five-star plan — or a plan of any rating for that matter — when you first become eligible for Medicare Advantage. Your eligibility begins once you are enrolled in both Medicare Part A and Part B (and you do not have End-Stage Renal Disease).
You are given a 7-month Medicare Initial Enrollment Period. This period begins three months before you turn 65 years old, includes the month of your birthday and continues for three months thereafter.
You are only eligible to enroll in plans that are offered in your area.
*If you are under 65 years old but qualify for Medicare because of a disability, you will be eligible to enroll in a Medicare Advantage plan following your 21st month of collecting disability benefits and will have until the end of your 28th month of collecting benefits to complete your enrollment.
If you are already enrolled in Part A and/or Part B, you may sign up for a Medicare Advantage plan during the fall Medicare Open Enrollment Period, which lasts from October 15 to December 7 each year.
If you are already enrolled in a Medicare Advantage plan, you may use this time to switch to a different Medicare Advantage plan.
If you already had Part A of Medicare but waited to sign up for Part B during the Medicare General Enrollment Period (January 1 to March 31 each year), you will be able to sign up for a Medicare Advantage plan between April 1 and June 30.
If you are currently enrolled in a plan that is rated as fewer than five stars, you may utilize the Medicare Five-Star Special Election Period to disenroll from your current plan and enroll in a five-star Medicare Advantage plan.
As mentioned above, this period lasts from December 8 to November 30 of the following year, which means you have almost an entire year to make the appropriate change. During this period, you can only switch to a five-star plan.
Being enrolled in a Medicare Advantage plan with fewer than five stars isn’t the only way to qualify for a Special Enrollment Period.
Special Enrollment Periods may be granted to individuals for a variety of circumstances, such as living outside of the U.S. at the time of your initial Medicare eligibility, or residing in a long-term care facility.
Call to speak with a licensed insurance agent today to learn more about the Medicare Advantage plan options near you.
According to the CMS, roughly 90 percent of all beneficiaries of Medicare Advantage plans that include prescription drug coverage (called MA-PD plans) are enrolled in 2022 Medicare Advantage plans rated 4 stars or higher. This means that around 9 out of 10 MA-PD beneficiaries are enrolled in a top-rated 2022 Medicare Advantage plan.
Approximately 68 percent of all MA-PD plans offered in 2022 are top-rated plans.2
The table below shows the distribution of MA-PD plans based on their Star Ratings.
|Overall Star Rating||Number of Plan Contracts||% of Total Plans (Weighted by Enrollment)|
|Average Star Rating (weighted by enrollment)||4.37|
Medicare Part D prescription drug plans (PDPs) are also given Medicare Star Ratings each year. About 52 percent of Part D plans in 2022 are rated 4 stars or higher. Roughly 42 percent of all Part D beneficiaries are in one of these top-rated plans in 2022.2
The table below shows the distribution of 2022 Medicare Part D plans based on their Star Ratings.
|Overall Star Rating||Number of Plan Contracts||% of Total Plans (Weighted by Enrollment)|
|Average Star Rating (weighted by enrollment)||3.7|
The Centers for Medicare & Medicaid Services started using the Star Rating system in 2007 to evaluate Medicare Advantage plan contracts. The goal of the Medicare Star Rating system is to help Medicare-eligible individuals and Medicare beneficiaries better understand the quality of the plans that are available on the market.
A 2015 report from the National Health Policy Forum suggested that not only do the Star Ratings help consumers in selecting quality plans, but potential increased payments plan contracts may receive from Medicare due to increased Star Ratings can result in the addition of new additional benefits and lower costs to plan beneficiaries.3
"The year-to-year increase in average star ratings, together with reduced
incidence of low ratings, suggests that many plans have put considerable
effort into improving performance on the range of measures." - Lisa Sprague, MBA, National Health Policy Forum Principal Policy Analyst3
Because high plan ratings may make a plan more attractive to consumers, insurance carriers are highly incentivized to improve their plans and earn higher Star Ratings.
1 Every year, Medicare evaluates plans based on a 5-star rating system.
2 CMS. Fact Sheet - 2022 Part C and D Star Ratings. (Oct. 8, 2021). Retrieved from https://www.cms.gov/files/document/2022-star-ratings-fact-sheet1082021.pdf.
3 Sprague, Lisa. (May 5, 2015). The Star Rating System and
Medicare Advantage Plans. National Health Policy Forum. Issue Brief 854. Retrieved from https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1279&context=sphhs_centers_nhpf.
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.
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