Key takeaways:
Medicare uses a star ratings system to help consumers compare the performance of private Medicare Advantage plans and Part D prescription plans.
The rating scale is from 1 star, which denotes poor performance, to 5 stars for excellent performance.
You can access and compare the star ratings for plans at www.medicare.gov.
If you’re considering joining, dropping, or switching to a Medicare Advantage plan or a Medicare Part D prescription plan, you may be wondering about the quality of the coverage for options available in your area. The Medicare Advantage and Part D star ratings system can help you choose a plan that suits your needs and has worked well for other enrollees.
What are Medicare star ratings?
Medicare star ratings are quality measures for original Medicare, Medicare Advantage, and Medicare Part D prescription plans. Hospitals, nursing homes, dialysis centers, and other entities paid by Medicare have their own star ratings.
Plan star ratings, which can change from year to year, are usually released in the fall, prior to the annual Medicare open enrollment period. Plans are rated from 1 to 5 stars, with 1 star denoting poor performance and 5 stars indicating excellent performance. The system also includes half-star ratings of 1.5, 2.5, 3.5, and 4.5.
How are star ratings calculated for Medicare Advantage and Part D plans?
Medicare Advantage and Part D plan star ratings are calculated based on patient surveys, information from insurance companies about their plans, and feedback from healthcare professionals. What’s measured depends on the type of plan. In the chart below, see the categories used to rate Medicare Advantage and Part D plans.
Star Rating Performance Categories
Medicare Advantage plan categories | Part D plan categories |
Ability to maintain health through screenings, tests, and vaccines | Plan customer service |
Ability to manage chronic conditions | How member complaints, problems getting services, and plan disenrollments are addressed |
Plan responsiveness and care | Member experiences with the plan |
How member complaints, problems getting services, and plan disenrollments are addressed | Medication pricing and patient safety |
Plan customer service |
Criticisms of the star system include:
Insurance companies self-report certain plan metrics and can exaggerate performance.
Plans that receive bonuses may not have shown improvement in clinical quality (how well healthcare professionals take care of enrollees).
Star ratings may not adequately reflect the experiences of enrollees who are Black or Hispanic or who have low incomes.
Highly rated plans may provide poorer outcomes for people from historically under-resourced communities.
Why is a star rating important for a Medicare plan?
In general, people enrolled in higher-rated plans have better health outcomes. Survey responses from enrollees provide feedback on three main areas:
Quality of care
Member experience
Customer service
Star ratings are important because they:
Help consumers make informed decisions about health plans
Incentivize plans to compete on quality and benefits, in addition to premiums
Translate into larger bonus payments for insurance companies with plans rated at 4 stars or higher
Can determine whether health plans get bonus payments, which may be used to enhance plan benefits and/or lower premiums
Different types of Medicare Advantage plans: Medicare Advantage plans are private alternatives to original Medicare. Learn about the 6 types and their rules, networks, and costs.
What Part D doesn’t cover: Medicare prescription plans cover a wide variety of medications, but there are some treatments, such as for erectile dysfunction and hair loss, they usually don’t.
Medicare open enrollment: The annual open enrollment period for Medicare runs from October 15 to December 7. Medicare Advantage has another open enrollment during the first three months of the year.
5-star Medicare Advantage and Part D plans
Five-star Medicare Advantage plans have an enhanced opportunity to receive enrollees. You can only enroll in a 5-star Medicare Advantage plan or 5-star Part D plan if one is available in your area.
You may have opportunities outside of your initial Medicare enrollment period (a 7-month window around the time you turn 65) and your annual open enrollment periods to join a 5-star Medicare Advantage plan. A 5-star special enrollment period is triggered if you have a 5-star plan available in your area that you want to join. You can use this special enrollment period only once from December 8 the year before the plan is listed as a 5-star plan to the following November 30.
If you move from a Medicare Advantage plan with Part D to a 5-star Medicare Advantage plan without it, you may lose your prescription medication coverage until your next open enrollment period. You may also have to pay the Part D late enrollment penalty. If you leave a Medicare Advantage plan with prescription medication coverage to join a 5-star standalone Part D plan, you will be enrolled in original Medicare (Part A and/or Part B) for coverage of your health services.
You can call 1-800-MEDICARE (1-800-633-4227) to use the 5-star special enrollment period.
How to use the Medicare star ratings when choosing a plan
Star ratings are one factor among many you should consider when choosing a Medicare Advantage and/or Part D plan. The most important thing is to choose an affordable plan in your area that aligns with your coverage needs. A plan with a 5-star rating may not be right for you.
With Medicare Advantage, for instance, make sure the plan you select works with the hospitals, doctors, and other healthcare professionals you want or require for care. (Hospitals, including cancer centers and specialty facilities, which may be the only options in a region, routinely decide not to accept Medicare Advantage plans in their areas.) If you are choosing a Part D plan or a Medicare Advantage plan with prescription coverage, make sure the plan’s formulary (list of covered medications) includes what you need at an affordable price. You should also make sure your preferred pharmacies are included.
Medicare plan finder
You can use the Medicare plan finder to see options available in your area. Once you enter the coverage year and your ZIP code, you will move through other pages asking the plan type you want to compare and other details. After making your selections, you will arrive at a page that lists the plans available to you. You can filter the results to see just 5-star plans, if there are any, in your area.
Under the plan name, insurance company offering the plan, and plan ID, you will see the star rating. A plan that has fewer than 3 stars for 3 years in a row will be flagged as low performing with a caution symbol (a red triangle with an exclamation point inside). If your current plan is marked with this symbol, you qualify for a special enrollment period to switch to a plan with 3 or more stars.
You can access free, unbiased help from local counselors at your State Health Insurance Assistance Program (SHIP). SHIP is available in all states, Washington, D.C., Guam, Puerto Rico, and the U.S. Virgin Islands. You can also call 1-800-MEDICARE (1-800-633-4227) with questions.
The bottom line
Check out the star ratings for Medicare Advantage and Part D plans to find out how they have performed in the areas of member experience, quality of care, and customer service. The rating scale is from 1 star, which denotes poor performance, to 5 stars for excellent performance. The system also includes half-star ratings of 1.5, 2.5, 3.5, and 4.5.
You can compare plans and see their ratings by using the Medicare plan finder. But don’t rely on star ratings alone. You should choose your Medicare Advantage plan and/or standalone Part D plan based on whether the benefits and costs meet your needs. Pay particular attention to the in-network hospitals and healthcare professionals for Medicare Advantage plans. Your required prescription medications and preferred pharmacies should be covered by the Part D plan you choose.
Why trust our experts?
References
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Emerson, J., et al. (2025). 33 health systems dropping Medicare Advantage plans - 2025. Becker’s Hospital Review.
Medicare.gov. (n.d.). Overall star rating for hospitals.
Medicare.gov. (n.d.). Overall star rating for nursing homes.
Medicare.gov. (n.d.). Quality of patient care for dialysis facilities.
Medicare.gov. (n.d.). Special enrollment periods.
Medicare Interactive. (2025). How to compare plans using the Medicare star rating system. Medicare Rights Center.
Meyers, D. J., et al. (2025). Flaws in the Medicare Advantage star ratings. JAMA Health Forum.
National Council on Aging. (2025). What are the Medicare star ratings?
Pifer, R. (2025). Winners and losers from 2026 Medicare Advantage star ratings. Healthcare Dive.
UnitedHealthcare. (n.d.). Medicare 5-star ratings.
