What Does It Mean If a Medicare Plan Has a 5-Star Rating?

You’ve heard of a 5-star hotel. But what about a 5-star Medicare plan? 

Normally, Medicare recipients can only change plans once during the open enrollment period, which is Oct. 15 through Dec. 7 each year. (The new coverage begins Jan. 1.) And the open enrollment period for Medicare Advantage plans is Jan. 1 through March 31 each year. If you’re enrolled in a Medicare Advantage plan, you can switch to another Medicare Advantage plan or switch to an Original Medicare plan once during that period. 

But with prestige comes privilege. Just like at a 5-star hotel, there are certain perks that come with a 5-star Medicare plan. If a Medicare or Medicare Advantage plan has a 5-star rating from the Centers for Medicare & Medicaid Services (CMS), you may change to that plan any time – but just once -- between Dec. 8 and Nov. 30, which, when you think about it, is nearly all year. This is known as the 5-Star Special Enrollment Period. 

Coincidentally, the CMS awarded two local, prominent insurance carriers 5-star ratings for 2022 – the first time that Vickie Davidson, KIG’s Medicare guru, has seen that occur in her nearly 20-year career. After all, in 2022, just 16% of Medicare Advantage plans with prescription drug coverage earned a 5-star rating, according to Healthcare.gov.  

The CMS’ star ratings for Medicare plans are as follows: 

• 5-star rating: Excellent
• 4-star rating: Above average
• 3-star rating: Average
• 2-star rating: Below average
• 1-star rating: Poor

What do they measure? 

The CMS uses information from member satisfaction surveys, plans and health care providers to bestow overall performance star ratings. The ratings are designed to help you compare plans based on quality and performance. Medicare updates these ratings each fall for the following year, and the ratings can change each year. 

For Medicare plans providing health coverage, plans are rated based on five categories. From the Centers for Medicare & Medicaid Services:  

1. Staying healthy: Whether members had access to preventive services to keep them healthy. This includes physical exams, vaccinations and preventive screenings.
2. Chronic condition management: Care coordination and how frequently members received services for long-term health conditions.
3. Member experience: Overall satisfaction with the health plan.
4. Member complaints: How frequently members submitted complaints or left the plan, whether members had issues getting needed services, and whether plan performance improved year over year.
5. Customer service: Quality of call center services and timely processing of appeals and new enrollments.

For Medicare Part D prescription drug plans and Medicare Advantage plans that include drug coverage, ratings are also based on the following criteria: 

• Member experience
• Member complaints
• Customer service
• Drug safety and accuracy of drug pricing 

If you’re interested in switching to a 5-star Medicare plan, feel free to reach out to Vickie Davidson, Client Advisor, at (724) 717-6005. 

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.