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Each year, Medicare Advantage and Part D plans are given a star rating based on overall quality and performance. The goal of the star rating system is to help Medicare members easily compare plans.
Medicare gives each plan a score on a scale of 1 to 5. These scores are based on various performance metrics. Under Medicare’s scoring system, a 3-star plan would be considered average and a 5-star plan would be considered excellent.
Rating Systen
In order to determine a plan’s star rating, Medicare compiles information obtained from the plan, providers, and member satisfaction surveys. Quality ratings are based on over 40 different metrics. Medicare looks at outcome indicators, meaning it considers how the health of the patient has changed while being on the plan. They also look at process indicators, such as the percentage of patients who had various health screenings performed.
Plans Incentivized to Improve
The majority of Medicare members are in high-scoring plans. In 2021, over 80% of Medicare Advantage and Part D members were in plans that earned at least 4 stars. This is a 4% increase from the previous year. Plans are incentivized to improve their member experience, which improves their overall star rating. 4-star plans and above receive an additional quality bonus from Medicare. In addition, plans with a 5-star rating are able to enroll members all year even if they are outside an enrollment period.
Know Your Plan's Star Rating
A plan’s star rating can change annually. Look for new plan ratings to come out in the fall. Every plan is obligated to disclose the plan’s star rating. You can find it on the insurance carrier’s website and in any enrollment materials provided to new members by the plan. It can also be located on Medicare.gov.
To find out your current plan’s star rating or to learn about other plans in your area, give us a call at 800-398-8714.
Christina Valenzuela
Christina Valenzuela is the co-owner of Vista Mutual Insurance Services, an insurance agency that focuses exclusively on the needs of Medicare beneficiaries. She has worked in the Medicare insurance industry since 2006 and is a licensed insurance producer in multiple states.
The information in this document has been gathered from Medicare.gov. and KFF (Kaiser Family Foundation).
Although we strive to be as accurate as possible, any differences between this document and the information on Medicare.gov will be governed by the information on Medicare.gov.
