What are Medicare “star ratings” and how are they measured?

Medicare rates Medicare Advantage and Part D (prescription drug plans) using something called Medicare stars. A 5-star rating is the best, while a 1-star rating is the worst. When you’re trying to choose a Medicare Advantage or Part D (prescription drug) plan, all the choices can be overwhelming. The star rating program was put in place to help you decide which plan is right for you. Medicare Advantage with prescription drug coverage (MA-PD) plans are rated on up to 44 unique quality and performance measures; MA-only plans (without prescription drug coverage) are rated on up to 32 measures, and stand-alone PDP plans are rated on up to 14 measures. The measures used to determine the ratings, including things like the following:

  • How the plan emphasizes staying healthy, including things like screenings, tests, and vaccines
  • How the plan manages chronic conditions
  • The quality of care people with the plan receive
  • Member complaint reports
  • Plan operations, including things like, how they make decisions about appeals, and the results of audits
  • Member experience

You can use the ratings, along with premiums, out-of-pocket costs, and benefits, to choose the right Medicare Advantage plan for you.

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