5-Star Medicare Advantage Plans

How is a five star Medicare Advantage plan measured?

  1. Screening tests and vaccines
  2. Management of chronic conditions
  3. Member experience with the plan
  4. Member complaints and changes in plan performance
  5. Customer service

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.

Woman smiles as doctor gives prescription

Highest rated Medicare Advantage plans

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:

Star Ratings

★★★★★

Excellent

★★★★

Above Average

★★★

Average

★★

Below Average

Poor

The rating system uses five key metrics in its assessment of a Medicare Advantage plan:

  1. Screening tests and vaccines
    This review criteria evaluates the level of access plan members have to preventive services, including annual physical exams, screenings, and vaccines.

  2. Management of chronic conditions
    This criteria includes the coordination of care under a given Medicare Advantage plan and evaluates how often members received treatment for long-term health conditions.

  3. Member experience with the plan
    This criteria evaluates plan members’ overall satisfaction with the given plan.  

  4. Member complaints and changes in plan performance
    How frequently did plan members submit complaints about the plan, have problems receiving covered services or opt out of the plan? This rating criteria also reflects whether the plan’s performance improved from the previous year.

  5. Customer service
    The quality of call center service and the efficiency of the appeals and enrollment process are closely evaluated as part of the overall plan customer experience.

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.  

How to find a five-star Medicare Advantage plan

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.

When to enroll in a five-star Medicare Advantage plan

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.

Compare plan Star Ratings online or speak to a licensed insurance agent today to switch to a 5 star Medicare Advantage plan if you're eligible by calling TTY Users: 711. We accept calls 24/7!

There are certain Medicare enrollment periods during which you may enroll in a five-star Medicare Advantage plan.

Initial Enrollment Period

1. When you first become eligible for Medicare Advantage

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.

Medicare AEP graphic

2. The fall Medicare Open Enrollment Period

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.

3. Between April 1 and June 30

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.

4. The Medicare Five-Star Special Enrollment Period

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.

5. A Special Election Period

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.

Explore Medicare Advantage plans in your area

Compare plans now

Or call 1-800-557-6059 (TTY: 711) to speak with a licensed insurance agent. We accept calls 24/7!

2021 Medicare Star Ratings for Medicare Advantage

According to the CMS, roughly 77 percent of all beneficiaries of Medicare Advantage plans that include prescription drug coverage (called MA-PD plans) are enrolled in 2021 Medicare Advantage plans rated 4 stars or higher. This means that more than 3 out of 4 MA-PD beneficiaries are enrolled in a top-rated 2021 Medicare Advantage plan.

Approximately 49 percent of all MA-PD plans offered in 2021 are top-rated plans.2

The table below shows the distribution of MA-PD plans based on their Star Ratings.

2021 Medicare Advantage Prescription Drug Plans Star Ratings
Overall Star Rating Number of Plan Contracts % of Total Plans
5 Stars 21 5.25%
4.5 Stars 64 16%
4 Stars 110 27.5%
3.5 Stars 140 35%
3 Stars 61 15.25%
2.5 Stars 4 1%
2 Stars 0 0%
Average Star Rating (weighted by enrollment) 4.06

2021 Medicare Star Ratings for Medicare Part D

Medicare Part D prescription drug plans (PDPs) are also given Medicare Star Ratings each year. About 42 percent of Part D plans in 2021 are rated 4 stars or higher. Roughly 17 percent of all Part D beneficiaries are in one of these top-rated plans in 2021. Around 98 percent of Part D beneficiaries are enrolled in plans rated 3.5 stars or higher.2

The table below shows the distribution of 2021 Medicare Part D plans based on their Star Ratings.

2021 Medicare Part D Prescription Drug Plans Star Ratings
Overall Star Rating Number of Plan Contracts % of Total Plans
5 Stars 5 9%
4.5 Stars 7 13%
4 Stars 11 20%
3.5 Stars 19 35%
3 Stars 9 16%
2.5 Stars 4 7%
2 Stars 0 0%
Average Star Rating (weighted by enrollment) 3.58

The Medicare Star Rating system

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.

Explore Medicare Advantage plans in your area

Compare plans now

Or call 1-800-557-6059 (TTY: 711) to speak with a licensed insurance agent. We accept calls 24/7!

Learn more about Medicare enrollment

 

1 Every year, Medicare evaluates plans based on a 5-star rating system.

2 CMS. Fact Sheet - 2021 Part C and D Star Ratings. (Oct. 13, 2020). Retrieved from https://www.cms.gov/files/document/2021starratingsfactsheet-10-13-2020.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.