5-Star Medicare Advantage Plans & What Star Ratings Mean
5-Star Medicare Advantage Plans & What Star Ratings Mean
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A 5-star Medicare Advantage plan has the highest-possible quality rating on Medicare.gov, meaning that the plan has good customer satisfaction and provides access to needed care.
If a 5-star plan is offered in your area, you can switch to it at any time by using a 5-star special enrollment period.
With this option, you don’t have to wait until open enrollment to change your coverage. In 2022, 5-star plans are offered in 35 states and Washington, D.C., though only about 27% of Medicare Advantage enrollees have a 5-star plan.
What Medicare star ratings mean
A Medicare star rating is a plan’s overall performance and quality score that's calculated across a wide range of criteria including customer satisfaction, access to health care and the rate of receiving preventative care. The amount of information that goes into star ratings makes them one of the most important criteria for choosing the best Medicare coverage.
Top 5-star Medicare Advantage plans
Medicare Advantage plans with five stars are top-tier plans that are considered "excellent" by the Medicare's administering agency, the Centers for Medicare & Medicaid Services (CMS).
It's not easy for a plan to earn this top-performance rank. In 2022, a 5-star rating was only given to 16% of contracts for Medicare Advantage plans that include prescription drug coverage. An "above average" ranking is much more common: 4- and 4.5-star plans account for half of all plans.
Most popular 5-star Medicare Advantage providers
- Most KP plans have 5 stars
- Limited doctor network
- Avg. cost: $57/mo.
- Provider's star rating is moderate overall, but its 5-star plans are popular
- Avg. cost: $25/mo.
- Subsidiary of Humana
- Only available in Florida
- Avg. cost: $0/mo.
These providers have the largest enrollment in 5-star Medicare Advantage plans, and average costs are for all 5-star plans offered by the provider.
Cost of 5-star plans in 2022
In 2022, it costs an average of $55 for a 5-star Medicare Advantage plan with prescription drug coverage. But in 92% of the counties where these top-ranking plans are offered, it's possible to sign up for a 5-star plan for $0 per month, providing a great option for coverage that's affordable and high quality.
The rates of 5-star plans from the largest insurance companies are affordable. For example, 5-star Medicare Advantage plans from Aetna cost $15 per month, Humana's 5-star plans cost an average of $20 per month, and 5-star plans from AARP/UnitedHealthcare cost an average of $25 per month.
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Are 5-star plans worth it?
A 5-star Medicare plan is a good choice because its high ratings show the plan provides good customer service, has satisfied policyholders, is well-managed and provides effective health care across a range of needs including diabetes, heart disease and preventative care.
Plus, 5-star plans are not necessarily more expensive. The cost of a Medicare Advantage plan is not determined by its quality ratings. Instead, cost is based on a plan's benefits, the size of the provider network, add-on perks, and other policy details. This means it’s possible to get a 5-star Medicare Advantage plan that costs $0, a very good deal for a top-performing plan.
Are 5-star Medicare Advantage plans popular?
In 2022, about 27% of policyholders are enrolled in a 5-star Medicare Advantage plan with prescription drug coverage. This is up significantly from 2021, when only 9% of enrollees had a 5-star plan.
This shift is largely due to the overall increase in star ratings across all plans during the COVID-19 health crisis. After the onset of the pandemic, the calculation methodology was amended to provide insurers with more leeway to prioritize medical claim processing over performance report production.
We expect the data to normalize in a few years, after the data collection cycle returns to its previous methodology. However, as more enrollees learn about the advantages of a 5-star plan, enrollment may continue to grow in locations where 5-star plans are available.
5-star special enrollment period
If a 5-star plan is available in your location, you qualify for a 5-star special enrollment period (SEP) that allows you to switch to a 5-star plan at any time during the year.
This means you can change your Medicare Advantage plan, even if it’s not Medicare open enrollment. By using 5-star special enrollment, you'll have easier access to the better-performing Medicare Advantage plans that are offered in your county.
Even if a better quality plan isn't your goal, those who have 5-star plans available can also use this enrollment period to change their medical benefits mid-year. For example, if you were enrolled in a 4-star plan and you're unhappy with your coverage, you can change your benefits by switching to a 5-star plan.
This workaround can be useful in situations that occur during the policy year, such as if you have a health diagnosis that requires more medical care or if your plan has disadvantages like high copays. Keep in mind that even if your intent is to change your medical coverage, you'll only be able to use a 5-star SEP to switch to a 5-star plan.
You can only use a 5-star SEP once per year between Dec. 8 and Nov. 30. This timing is centered around the traditional fall open enrollment period, allowing changes any time except the last week of open enrollment.
Where 5-star special enrollment can be used in 2022
A 5-star plan must be available in your area for you to be eligible to use the 5-star SEP. However, 5-star plans are more widely available than you may expect.
Five-star plans are available in 35 states and Washington, D.C. Plan availability changes by county, and top-rated plans are available in 29% of U.S. counties.
States where 5-star Medicare Advantage plans are available:
- Alabama
- Arizona
- California
- Colorado
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Missouri
- Nevada
- New Hampshire
- New Jersey
- New York
- North Carolina
- Ohio
- Oregon
- Pennsylvania
- Rhode Island
- Tennessee
- Texas
- Utah
- Virginia
- Washington
- Washington, D.C.
- Wisconsin
How Medicare star ratings are calculated
Each Medicare plan's overall star rating is a weighted average of several different data points. This means it's a robust measurement that can help you understand which are the best-performing Medicare plans in your area.
For Medicare Advantage plans with prescription drug coverage, 40 measurements are used in the overall score. This includes analysis of both Part C medical benefits and Part D prescription drug benefits. For a standalone Medicare Part D plan for prescription drugs, 12 measurements are combined into the overall score.
The individual measurements are grouped into five categories, each revealing something different about the health insurance plan. For example, patient survey questions can reveal how satisfied policyholders are with their plan.
Categories for star rating measurements | What it tells us |
|---|---|
| Patient experience | Customer satisfaction |
| Process measurement for improving health status | Rate at which policyholders use preventative care |
| Access to care and customer service | How well policyholders are served |
| Improvement measure | How a plan is changing each year |
| Health outcomes | Quality of care and progress towards better health |
To calculate the overall score, the 40 individual measurements for Part C and Part D are weighted based on which category they're in. For example, each measurement in the patient experience category will be worth two points. Improvement measures are worth five points, outcomes are worth three points, access measurements are worth two points and process measurements are worth one point each.
Medicare Part C star rating calculation
A Medicare Part C star rating is calculated by combining 28 measurements across the five categories. Patient experience has the largest impact on the overall score, accounting for 36% of the Part C star rating.
Patient experience: 36%
Medicare Part C rating metric | Description from CMS |
|---|---|
| Rating of health plan | Members' overall view of their health plan. (From survey) |
| Rating of health care quality | Member rating of the quality of the health care they received. (From survey) |
| Customer service | How easy it is for members to get information and help from the plan when needed. (From survey) |
| Complaints about the plan | Percentage of members filing complaints with Medicare about the health plan. |
| Members choosing to leave the plan | Percentage of plan members who chose to leave the plan. |
| Getting needed care | Ease of getting needed care and seeing specialists. (From survey) |
| Getting appointments and care quickly | How quickly the member was able to get appointments and health care. (From survey) |
| Care coordination | How well the plan coordinates members’ care including following up after tests and if doctors had accurate patient records. (From survey) |
Process measurement: 33%
Medicare Part C rating metric | Description from CMS |
|---|---|
| Yearly flu vaccine | Percentage of plan members who got a flu shot. |
| Breast cancer screening | Percentage of female plan members aged 52-74 who had a mammogram during the past two years. |
| Colorectal cancer screening | Percentage of plan members aged 50-75 who had appropriate screening for colon cancer. |
| Monitoring physical activity | Percentage of senior plan members who discussed exercise with their doctor and were advised to start, increase or maintain their physical activity. |
| Care for older adults: medication review | Percentage of plan members whose doctor or pharmacist reviewed a list of everything they take at least once a year (includes prescription and nonprescription drugs, vitamins, herbal remedies and other supplements). |
| Special needs plan (SNP) care management | Percentage of eligible SNP enrollees who received a health risk assessment (HRA) during the measurement year. |
| Care for older adults: pain assessment | Percentage of plan members who had a pain screening at least once during the year. |
| Osteoporosis management in women who had a fracture | The percentage of female enrollees aged 67 to 85 who broke a bone and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture. |
| Diabetes care: eye exam | Percentage of plan members with diabetes who had an eye exam to check for damage from diabetes during the year. |
| Diabetes care: kidney disease monitoring | Percentage of plan members with diabetes who had a kidney function test during the year. |
| Rheumatoid arthritis management | The percentage of plan members who were diagnosed with rheumatoid arthritis during the measurement year and who got one or more prescriptions for an anti-rheumatic drug. |
| Reducing the risk of falling | The percentage of Medicare members aged 65 and older who had a fall or had problems with balance or walking in the past 12 months and who received a recommendation for how to prevent falls or treat balance problems. |
Access to care and customer service: 13%
Medicare Part C rating metric | Description from CMS |
|---|---|
| Reviewing appeals decisions | How often an independent reviewer upheld a plan's decision to deny coverage as a percentage of all appeals. |
| Plan makes timely decisions about appeals | Percentage of coverage appeals that are processed in a timely way as percentage of all the plan‘s appeals. |
| Call center: foreign language interpreter and TTY | Percentage of time that TTY services and foreign language interpretation were available when needed by people who called the health plan’s prospective enrollee customer service phone line. |
Improvement measure: 11%
Medicare Part C rating metric | Description from CMS |
|---|---|
| Health plan quality improvement | How much the health plan’s performance improved or declined from one year to the next, based on star ratings. |
Health outcomes: 7%
Medicare Part C rating metric | Description from CMS |
|---|---|
| Diabetes care: blood sugar controlled | Percentage of plan members with diabetes who had an A1C lab test during the year that showed their average blood sugar is under control. |
Medicare Part D star rating calculation
Medicare Part D star ratings include 12 measurements across the five categories, and ratings apply to both standalone Part D plans and the prescription drug benefits included with most Medicare Advantage plans.
Accounting for 41% of the overall score, the health outcomes category has the largest impact on overall Medicare Part D star ratings. This category looks at the rate at which most policyholders are filling their prescriptions, thus revealing if the plan's benefits for common medications are both affordable and accessible.
Health outcomes: 41%
Medicare Part D rating metric | Description from CMS |
|---|---|
| Medication adherence for diabetes medications | Percentage of plan members with a prescription for diabetes medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication. |
| Medication adherence for hypertension (RAS antagonists) | Percentage of plan members with a prescription for a blood pressure medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication. |
| Medication adherence for cholesterol (statins) | Percentage of plan members with a prescription for a cholesterol medication who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication. |
| Statin use in persons with diabetes (SUPD) | Percentage of plan members with diabetes who take the most effective cholesterol-lowering drugs to lower their risk of developing heart disease. |
Patient experience: 28%
Medicare Part D rating metric | Description from CMS |
|---|---|
| Rating of drug plan | Member rating of the quality of the prescription drug plan. (From survey ratings) |
| Getting needed prescription drugs | Ease of getting medicines their doctor prescribed, including using the plan, local pharmacies and prescriptions by mail. (From survey) |
| Complaints about the drug plan | Percentage of members filing complaints with Medicare about the health plan. |
| Members choosing to leave the plan | Percentage of plan members who chose to leave the plan. |
Improvement measure: 17%
Medicare Part D rating metric | Description from CMS |
|---|---|
| Drug plan quality improvement | How much the drug plan’s performance improved or declined from one year to the next, based on star ratings. |
Access to customer service: 7%
Medicare Part D rating metric | Description from CMS |
|---|---|
| Call center: foreign language interpreter and TTY | Percentage of time interpreter and TTY was available for those who needed it, out of the total number of attempted contacts with these services. |
Process measurement: 7%
Medicare Part D rating metric | Description from CMS |
|---|---|
| MPF price accuracy | Accuracy of pricing between what members actually pay for their drugs versus the plan's drug prices on the Medicare Plan Finder. |
| MTM program completion rate for CMR | Members who had a pharmacist or other health professional help them understand and manage their medications. |
How to use star ratings to choose a plan
When choosing a Medicare Advantage plan, we recommend that shoppers weigh three factors in tandem:
- Overall star rating
- Cost
- Medical benefits
The best plan balances all three factors — a plan won't be a good fit if it is too expensive, is poorly rated, or doesn't have the right level of coverage for you.
We recommend you start by looking at the top-rated plans in your area including 5-star plans and 4.5-star plans. Then compare the costs and medical benefits offered by these options.
We generally recommend enrolling in the highest-star plan you can because this can help you feel confident that you'll get hassle-free coverage. However, there are times when it may be worth it to choose a lower-star plan.
For example, a 4- or 4.5-star plan may be a better choice than a 5-star plan if:
- Your preferred doctor was in that plan network
- The plan's benefits better match your medical needs, such as providing specialized cancer treatment
- The plan's list of covered medications is a better match for your current prescriptions
When do Medicare star ratings come out?
CMS star ratings are released each October before fall open enrollment.
While there is no formal date set for the data release, it usually happens on Oct. 8, a week before open enrollment begins on Oct. 15. In 2022, Oct. 8 is on a Saturday, so we expect that the 2023 Medicare Star Ratings will be released on either Friday, Oct. 7 or Monday, Oct. 10.
Frequently asked questions
What are CMS Medicare star ratings based on?
Medicare star ratings are calculated using 40 criteria across Part C and Part D coverage. This includes survey data about member satisfaction, calculations about the number of complaints, outcomes such as how often those with diabetes fill their prescriptions and more. The in-depth calculation makes it a helpful tool for choosing the best Medicare Advantage plans.
What does a CMS 5-star rating mean?
A 5-star Medicare plan has earned the best-possible rating for quality and performance. If a 5-star plan is available in your area, you can switch to it at any time using a 5-star special enrollment period.
What is the highest rating for a Medicare Advantage plan?
A 5-star Medicare Advantage plan has the highest possible rating. Plans are ranked on a scale of 1 star to 5 stars. Only 16% of contracts have achieved a 5-star rating in 2022.
Can you get a $0 Medicare Advantage plan with 5-stars?
Yes, in 92% of the counties where 5-star plans are available, you can get a free Medicare Advantage plan that also has 5 stars. However, the cost of a plan is largely determined by the plan's level of medical benefits. For example, a 5-star plan costing $0 would be high quality, but you may also have to pay more when you receive medical care.
Why are star ratings important when choosing a Medicare plan?
Medicare star ratings tell you about a plan's quality and performance across a range of criteria. This can tell you the rate of customer satisfaction, how well policyholders are served, and if the plan helps policyholders to become healthier.
Methodology
Data and analysis is based on Centers for Medicare & Medicaid Services (CMS) public use files, fact sheets and technical notes. Medicare Advantage analysis only includes plans that include prescription drug coverage and excludes employer-sponsored plans, special needs plans, PACE plans, sanctioned plans and health care prepayment plans (HCPPs).
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