Medicare Advantage Star Ratings: How to Find the Best Plan
Medicare Advantage Star Ratings are a 1-to-5 quality score from the Centers for Medicare & Medicaid Services (CMS) that measures how well a plan performs in areas like preventive care, chronic disease management, member satisfaction, and customer service. A 5-star plan is the highest rated, but the best plan for you isn’t always the one with the most stars — you also need to check costs, provider networks, and drug coverage. Here’s how to use Star Ratings as a tool, not the final word, when choosing a plan.
Quick answer
Star Ratings are published each year by CMS on the Medicare Plan Finder (medicare.gov/plan-compare). Plans are rated on a 1-to-5 scale based on up to 40 quality measures grouped into five categories:
- Health plan quality – preventive screenings, chronic condition management, timely care
- Member experience – satisfaction surveys, ease of getting care
- Customer service – plan responsiveness, complaints, appeals processing
- Drug plan quality – Part D drug safety, pricing accuracy, member satisfaction with pharmacy
- Overall rating – a weighted composite score
How to use them to choose a plan:
1. Filter plans on Medicare.gov by overall Star Rating (4 stars or higher recommended for most people).
2. Check individual measures that matter to you — a plan can have 5 stars overall but score poorly on chronic condition management.
3. Cross-reference ratings with costs (premiums, deductibles, copays) and network coverage.
4. Confirm your preferred doctors and hospitals accept the plan.
5. Look for the 5-star enrollment period: if a plan earns 5 stars, you can switch into it once between December 8 and November 30 of the following year, outside normal enrollment windows.
Important: Star Ratings change annually. A 5-star plan this year may drop to 4 stars next year, so review ratings during each Annual Enrollment Period (October 15 – December 7).
Where Star Ratings apply (and where they don’t)
Star Ratings are only assigned to Medicare Advantage plans (Part C) and standalone Part D prescription drug plans. They do not apply to:
- Original Medicare (Part A and Part B)
- Medicare Supplement (Medigap) policies
- Medicare Medical Savings Account (MSA) plans
Additionally, ratings are plan-specific and county-specific. The same insurance company may have a 5-star plan in one county and a 3-star plan in a neighboring county due to differences in local provider networks and member populations. If you move or change counties, the ratings for your current plan may change.
What this means for your choice: If you’re using Star Ratings to decide, you must filter by your specific zip code and check ratings for the county where you live. Do not assume a plan with a high rating in a different area will perform the same in yours.
Comparison framework
How Star Ratings are calculated
CMS assigns each plan a rating using data from member surveys, claims data, and complaint records. The measures are weighted:
| Category | Weight | Example measures |
|---|---|---|
| Staying healthy (screenings, tests, vaccines) | 22% | Breast cancer screening, flu shots, blood pressure control |
| Managing chronic conditions | 22% | Diabetes care (HbA1c control, eye exams), heart disease management |
| Member experience | 20% | Overall satisfaction, ease of getting needed care |
| Customer service | 18% | Plan responsiveness, complaints per 1,000 members, appeal timeliness |
| Part D (drug plan) | 18% | Drug safety, member satisfaction with pharmacy, accurate drug pricing |
A plan’s overall rating is the weighted average of all measures, rounded to the nearest half-star.
How to read a Star Rating
| Rating | What it means | Should you consider it? |
|---|---|---|
| 5 stars | Excellent performance across all measures | Strong candidate, but still verify costs and network |
| 4 stars | Above average | Very good choice; often better value than 5-star plans |
| 3 stars | Average | Acceptable; check individual measures for weak spots |
| 2 stars | Below average | Proceed with caution; review complaint history and quality gaps |
| 1 star | Poor | Avoid unless no other option exists in your area |
Key insight: A 4-star plan may offer lower premiums and better drug coverage than a 5-star plan in the same county. The star rating measures quality, not affordability or network breadth.
Best-fit picks by use case
Use case 1: You manage multiple chronic conditions
Prioritize plans with 4 or more stars in the “Managing chronic conditions” category, even if the overall rating is lower. A plan with 4 stars overall but 5 stars in diabetes or heart disease measures will likely serve you better than a 5-star plan that scores average on chronic care.
Check: On Medicare.gov, click “View plan details” and look for the individual measure scores under “Health plan quality.”
Real world example: In 2025, a 4-star plan in Cook County, Illinois, scored 5 stars on diabetes care (HbA1c control and eye exams) while a 5-star plan in the same county scored only 3 stars on that measure. The 4-star plan also had a $0 monthly premium and covered more diabetes medications. The higher overall rating did not equal better chronic care.
Use case 2: You take several prescription drugs
Star Ratings include Part D measures, but they don’t tell you if your specific drugs are covered or what tier they fall under. A plan with 5 stars for drug plan quality may still place your medication in a high-cost tier.
Action: Use Medicare.gov’s “Plan Compare” tool to enter your drugs and see estimated annual costs. Then filter by Star Rating to find a high-quality plan that also covers your medications affordably.
Verification step: After entering your drugs, look at the “Drug Cost Details” column. If a drug is listed as “Not Covered” or has a high tier (e.g., Tier 5 specialty), that plan may not be a good fit even if it has 4.5 stars.
Use case 3: You want the lowest monthly premium
Star Ratings do not reflect costs. A 3.5-star plan may have a $0 monthly premium and a $0 deductible, while a 5-star plan in the same area may charge $150 per month plus copays. If you’re on a fixed income, a lower-rated plan with manageable out-of-pocket costs may be the better choice.
Check: Sort plans by “Estimated total annual cost” (premiums + deductibles + copays) on Medicare.gov, then look at Star Ratings as a tiebreaker.
Trade-off warning: A $0-premium 3.5-star plan may have a narrow network or high copays for specialist visits. Use the provider finder tool to see if your doctors are in-network. If they are not, the low premium won’t matter because you’ll pay more for out-of-network care.
Decision checklist (5 actionable checks)
Use this list when comparing plans. Each item is a pass/fail check.
| # | Check | Pass / Fail |
|---|---|---|
| 1 | Overall Star Rating is 3.5 stars or higher | ☐ Pass ☐ Fail |
| 2 | Rating for “Managing chronic conditions” meets your needs (if applicable) | ☐ Pass ☐ Fail |
| 3 | Your primary care doctor and specialist are in-network | ☐ Pass ☐ Fail |
| 4 | Your prescription drugs are covered at a reasonable cost | ☐ Pass ☐ Fail |
| 5 | Estimated total annual cost (premium + deductible + copays) is within your budget | ☐ Pass ☐ Fail |
If all five pass, the plan is a strong candidate. If two or more fail, keep looking.
Trade-offs to know
The counter-intuitive angle: A 5-star plan can be a bad fit
A 5-star plan means the plan delivers high-quality care and service on average. But it does not mean:
- Your specific doctors accept it
- Your drugs are covered at the lowest cost
- The premium or deductibles are affordable
- The plan covers all the benefits you need (dental, vision, hearing, transportation)
Example: In 2025, a 5-star Medicare Advantage plan in a major metro area may charge a $200 monthly premium and have a $500 drug deductible. A 4-star plan in the same county may have a $0 premium and a $150 drug deductible. If both cover your doctors and drugs, the 4-star plan is likely the better value.
Common failure cases to avoid
Failure case 1: Choosing by overall rating alone
You pick a 5-star plan, then discover your cardiologist is out-of-network. Star Ratings do not include network data. Always verify network participation before enrolling.
Failure case 2: Ignoring year-to-year rating changes
A plan you enrolled in last year as 4.5 stars may drop to 3 stars this year. Check ratings annually during AEP (October 15 – December 7) and switch if needed.
Failure case 3: Assuming 5-star = best drug coverage
Part D star measures evaluate safety and member satisfaction, not whether your specific drugs are on the formulary. A plan with 5 stars for drug plan quality may still exclude your medication. Always use the drug pricing tool.
Failure case 4: Overlooking the 5-star enrollment period
If a plan earns 5 stars, you can join it once between December 8 and November 30 of the following year, even outside AEP or your initial enrollment period. This is a valuable option if a 5-star plan becomes available mid-year. But don’t wait for a 5-star plan to appear if a good 4-star plan is available now.
How to evaluate a plan using Star Ratings (operator flow)
1. Start with your priorities – Write down what matters most: low monthly cost, specific chronic care management, broad provider network, or prescription drug coverage.
2. Go to Medicare.gov/plan-compare – Enter your zip code, drugs, and preferred pharmacies.
3. Filter by Star Rating – Set a minimum of 3.5 stars. Note: plans with fewer than 3 stars rarely appear in results.
4. Check individual measures – Click “View plan details” and look at the scores for “Managing chronic conditions” and “Member experience.” A plan with 4 stars overall but 5 stars in chronic care may be ideal.
5. Compare estimated annual costs – Sort by “Estimated total annual cost” and review the top 5–10 plans.
6. Verify network – Call the plan or use the provider finder tool to confirm your doctors and preferred hospital are in-network.
7. Make your choice – Select the plan that passes all five items in the decision checklist.
Checkpoint: If you reach step 6 and your doctors are out-of-network, go back to step 4 and look at the next plan. Do not skip network verification.
Success signal: You’ve found a plan with at least 3.5 stars, your doctors in-network, your drugs covered at a reasonable cost, and an estimated annual cost within your budget.
Escalation signal: If no plan with 3.5 stars or higher meets all your criteria, consider a 3-star plan or look into Original Medicare (Part A and Part B) with a standalone Part D plan and a Medigap policy. Some areas have limited Medicare Advantage options.
Related questions
What is the 5-star enrollment period for Medicare Advantage?
If a plan in your area earns a 5-star rating overall, you can switch into that plan once between December 8 and November 30 of the following year, regardless of other enrollment windows. You can only use this exception for that specific 5-star plan.
How often do Star Ratings change?
CMS publishes new ratings every October for the following plan year. A plan’s rating can move up, down, or stay the same. Check ratings annually during the Annual Enrollment Period (October 15 – December 7).
Do Star Ratings apply to Medicare Supplement (Medigap) plans?
No. Star Ratings only apply to Medicare Advantage plans (Part C) and Part D prescription drug plans. Medigap plans are standardized by law and not rated by CMS in the same way.
Can I use Star Ratings to compare plans in different counties?
Yes, but ratings are plan-specific and county-specific. A plan offered by the same insurance company may have different ratings in different counties based on provider networks and member populations. Always check the rating for your specific county.
Medicare rules, premiums, and Star Ratings change annually. The standard Part B premium in 2025 is $185.00 per month, and the Part B deductible is $257.00. IRMAA (Income-Related Monthly Adjustment Amount) surcharges apply to higher-income beneficiaries. Verify all plan details, ratings, costs, and network participation at Medicare.gov or by calling 1-800-MEDICARE before enrolling. This article provides general guidance and does not constitute financial, legal, or medical advice.
Mike Spencer is the lead researcher at ssfaq.com, specializing in Social Security benefits, Medicare enrollment, and retirement planning. With years of experience analyzing SSA and CMS policy, he translates complex government regulations into clear, actionable guidance for retirees, near-retirees, and disabled workers. Every article is researched using official SSA.gov, Medicare.gov, and IRS.gov sources.