Medicare Star Ratings are a yearly report card for health and drug plans. Medicare scores each plan from one star to five stars. Five stars means excellent. One star means poor.
Who this is for
- Your plan's new star rating, up or down from last year.
- Your drug list, which can change even when the stars hold steady.
- Any higher rated plan that entered your area for the coming year.
- Your renewing plan's new costs, since doing nothing accepts them.
What you get
Clinical quality records
Plans report how often members get screenings, tests, and vaccines.
Member surveys
Medicare asks members directly about their care, service, and appointment access.
Health outcome surveys
Members report how their health and daily function change over time.
Medicare's own files
CMS tracks complaints, appeals, call center accuracy, and members who leave.
What Are Medicare Star Ratings?
Medicare Star Ratings are a yearly report card for health and drug plans. Medicare scores each plan from one star to five stars. Five stars means excellent. One star means poor.
The Centers for Medicare and Medicaid Services, known as CMS, publishes the scores each fall. They arrive just before Annual Enrollment opens on October 15. The rating you see applies to the coming plan year, not the year you are finishing.
- The CMS star scale, where five is excellent.
- 1 to 5The CMS star scale, where five is excellent.
- Ratings move in half star steps.
- Half starsRatings move in half star steps.
- New ratings publish before Annual Enrollment.
- Every fallNew ratings publish before Annual Enrollment.
The short version
Star Ratings cover Medicare Advantage plans and Part D drug plans.
Medigap policies are not rated this way.
The stars describe the plan, not your own doctor and not your own hospital.
How Does CMS Score a Plan?
CMS builds each score from dozens of separate measures. Some come from clinical records. Some come from member surveys. Some come from Medicare's own service records.
Where the data comes from
Clinical quality records
Plans report how often members get screenings, tests, and vaccines.
Member surveys
Medicare asks members directly about their care, service, and appointment access.
Health outcome surveys
Members report how their health and daily function change over time.
Medicare's own files
CMS tracks complaints, appeals, call center accuracy, and members who leave.
Those measures roll up into categories. A Medicare Advantage plan with drug coverage earns one overall star rating. A standalone Part D plan earns a rating built only from drug measures.
Half stars count
Ratings move in half star steps, so you will see scores like 3.5 or 4.5. A half star gap can reflect real differences in service and follow up.
What Do the Stars Actually Measure?
The categories are simpler than they sound. Each one answers a plain question about how the plan treats its members.
- Staying healthy. Do members get the screenings, tests, and shots they should?
- Managing chronic conditions. Does the plan help members with diabetes or heart disease stay on track?
- Member experience. Do members say care is easy to reach and easy to use?
- Complaints and plan changes. How often do members complain, appeal, or leave?
- Customer service. Does the plan answer calls, decide appeals, and keep records well?
- Drug safety and pricing. Are prescriptions used safely, and is drug pricing posted correctly?
What a star rating does and does not tell you
What the stars capture
Quality and service across the whole plan.
- Service
- Call center accuracy, appeal handling, and complaint volume.
- Preventive care
- How often members get recommended screenings and vaccines.
- Member voice
- Survey answers about access, care, and coordination.
- Stability
- How many members choose to leave the plan.
What the stars miss
The details that decide your own year.
- Your doctors
- Stars do not tell you whether your physician is in network.
- Your drugs
- Stars do not price your prescriptions on the plan's drug list.
- Your budget
- Premiums, copays, and the yearly limit sit outside the score.
- Your area
- One rating can cover a contract that spans many counties.
How Much Weight Should a Star Rating Carry?
Treat the rating as one input, not a verdict. It works well as a screen and poorly as the only reason to buy. A four star plan that drops your cardiologist is still the wrong plan for you.
- Start with your doctors and your drug list, then look at the stars.
- Compare ratings only among plans you would actually accept.
- Give extra weight to customer service and complaint measures.
- Look at the trend, because a plan that keeps slipping may keep slipping.
- Remember that one contract can cover many counties, so local service varies.
Watch for the low performing icon
Medicare flags plans that score below three stars for three years in a row. The flag shows up on Medicare Plan Compare. Treat it as a reason to look hard at your other options.
Stars describe the plan. Your doctors, your drugs, and your budget describe your year.
What Is the Five Star Special Enrollment Period?
A top rating comes with a rare privilege. If a five star plan serves your area, you may switch to it outside the normal windows.
How the five star window works
- 01
Check whether a five star plan serves you
Five star plans are uncommon, and many counties have none at all.
- 02
Use the window one time
The chance runs from December 8 through November 30 of the following year.
- 03
Know what you may switch to
You may move to a five star Medicare Advantage plan or a five star Part D plan.
- 04
Protect your drug coverage
Moving to a plan without drug coverage can leave a gap. Check that first.
Ask before you jump
A five star plan is not automatically better for you. Confirm your doctors and prescriptions first. Our licensed agents review that at no cost to you.
How Do You Compare Star Ratings in Orange County?
Orange County shoppers usually face a long list of plans. Ratings help you shorten that list quickly, as long as you use them in the right order.
A simple way to shop
- 01
List your must haves
Write down your doctors, your hospitals, and every prescription you take.
- 02
Filter by network first
Set aside any plan that leaves out the providers you rely on.
- 03
Price your prescriptions
Check each plan's formulary, which is the plan's list of covered drugs.
- 04
Then read the stars
Among the plans that still fit, favor the higher and steadier ratings.
- 05
Confirm with a licensed agent
We verify current ratings and benefits with you before you sign anything.
We are an independent agency in Orange, so we compare many carriers side by side. Start with our plan comparison tools, then book a review in person, by video, or by phone. We help in English and Spanish, with Korean, Mandarin, and Vietnamese available.
Where Do Star Ratings Fit in Your Annual Review?
Ratings change every year, and so does your health. That pairing is exactly why an annual review matters.
Check each fall
Four things to look at before December 7
- Your plan's new star rating, up or down from last year.
- Your drug list, which can change even when the stars hold steady.
- Any higher rated plan that entered your area for the coming year.
- Your renewing plan's new costs, since doing nothing accepts them.
Bottom line
Use the stars to shorten your list. Use your doctors, your drugs, and your budget to make the final call.