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By understanding what a five-star rating means, you can confidently select a plan that ensures high-quality care and excellent customer service.

Sept. 2, 2025

Choosing the best Medicare plan for your physical, mental and financial wellness can feel hard. Not only do you want to make sure you’re making the right choice to maximize your health care coverage, but you also need to think about what your out-of-pocket costs may be. But, don’t worry.

The Centers for Medicare & Medicaid Services (CMS) developed the Medicare Star Ratings system to help Medicare-eligible people and enrollees find the top-rated plans easily. The system rates plans based on how good they are and how well they work. This makes it easier to find a good Medicare plan.

Understanding what these ratings mean—and what a five-star rating means—can help you shop Medicare Advantage or Medicare Part D prescription drug plans with confidence.1

Understanding the Medicare Star Rating system

The Star Rating system for Medicare plans ranks Medicare Advantage (Medicare Part C) and Medicare Part D plans from a scale of 1 to 5, with 1 being the lowest and 5 being the highest. In other words, it ranks private Medicare plans on a five-point scale to decide how well each plan meets member needs.1

CMS rates star-rated plans every year based on thorough criteria to make sure plans are properly rated.2 Medicare Part C and Medicare Part D plans are rated on different criteria. Here are the criteria used for each plan’s rating.

CMS uses more than 40 performance measures when rating Medicare Advantage and Part D plans. These include:

  • Timeliness of appointments and screenings
  • Effectiveness of chronic health problem care (for example blood sugar and blood pressure control)
  • Member-reported satisfaction by way of surveys
  • Call center hold times and accuracy of information
  • How many complaints and how many members leave the plan by themselves.

Each measure is given a weight. For instance, outcomes related to managing chronic health problems are weighted more heavily than administrative functions. CMS calculates the overall rating based on a weighted average. Plans that get high scores in all these areas get the five-star rating.1

There are 5 unique categories Medicare Advantage plans are rated on:

  • 1. Chronic conditions: How often members with certain long-term health issues get recommended care to help manage their condition affects the plan’s overall rating.
  • 2. Staying healthy: How often members get preventive healthcare, like check-ups, vaccines, and screenings, to stay healthy helps improve the plan’s overall rating.
  • 3. Member reviews: What members say about their experience with a health plan is considered when giving the plan a rating.
  • 4. Customer service: How well a plan deals with member appeals and complaints affects its rating.
  • 5. Plan performance: The kinds of member complaints and changes in how well the plan works are also used to give the plan a rating. Aspects of plan performance that may be considered include how often CMS finds issues with the plan, how much the plan has gotten better over time, and how often plan members had problems.

There are four categories Medicare Part D (prescription drug) plans are rated on:

  • 1. Member reviews: Similar to Medicare Advantage plan ratings, members’ reviews of their personal experience with the Part D plan contribute to the plan rating.
  • 2. Customer service: Similar to Medicare Advantage plan ratings, how well the plan responds to and handles customer complaints contributes to the plan rating.
  • 3. Plan performance: Similar to Medicare Advantage plan ratings, Medicare Part D plans are also rated on the plan’s performance. Aspects of plan performance that may be considered include how often CMS finds problems with the plan, how much the plan’s performance has improved over time (if at all), and how frequently plan members had issues with the plan.
  • 4. Drug safety and pricing: The plan’s accuracy in drug pricing and how often people with certain health conditions get safe and recommended drugs help determine the rating.

Updated plan ratings are ready every October, and if a plan doesn’t have a rating, it’s because it’s new to the Marketplace. Medicare created this system to help you easily compare plans based on quality, customer satisfaction and service excellence, beyond just cost.3

What exactly does a five-star rating mean?

Now, you might be wondering what it truly means if a Medicare plan has been awarded a five-star rating. In simple terms, you can assume that the plan has been carefully checked and is one of the best options for quality, customer care, and overall service.1

If a Medicare plan has a five-star rating, it typically means that it has:

  • High member satisfaction: Five-star rated plans have very few complaints, which means members are happy with the plan and its customer service.
  • Excellent care management: Plans efficiently manage preventive care, chronic conditions and medication use.
  • Low member complaints: Few members file complaints because they’re happy with the plan and its services.
  • Low member turnover: Highly rated plans generally have higher rates of members who stay on the plan because they’re happy with the plan.
  • Efficient and accurate prescription management: If you’re reviewing a Medicare Part D plan, highly rated plans will have good oversight and management of member prescription drug use.2

It is difficult for a plan to earn a five-star rating—and for good reason. The rating system is supposed to help bolster your confidence in shopping, so five-star ratings are only given when they’re earned. For reference, less than 10% of Medicare Advantage or Medicare Part D plans were five-star rated in 2024.1

How to find a Medicare plan’s rating

Finding a Medicare plan’s rating is simple. Visit the CMS’s site and navigate to the Medicare Plan Finder. From there, you’ll enter your zip code and then you’ll be able to view the specific plans available to you in your area. Each plan will have its current Star Rating. You can click on the star rating to see a detailed breakdown of how each plan scored in the rating categories.3

How can I become a member of a five-star Medicare plan?

If a five-star plan is available in your area, you may qualify to use the Five-Star Special Enrollment Period (SEP) to switch plans. This opportunity is available once and occurs between Dec. 8 of one calendar year through Nov. 30 of the following year after the annual Open Enrollment Period ends.2

You can also join a highly rated Medicare Advantage or Part D plan during the following periods:

  • Initial Enrollment Period (IEP): For those new to Medicare — this window includes the three months before your 65th birthday, your birthday month and the three months after.
  • Open Enrollment Period (OEP): Runs from Oct.15 to Dec. 7 each year. During this time, current Medicare users can change plans.
  • Special Enrollment Period (SEP): Available to people who meet specific conditions outside of IEP or OEP.

When can I use a Special Enrollment Period?

  • From Dec. 8 to Nov. 30, if you’re switching to a five-star plan.
  • Anytime between Jan. 1 and Dec. 31, if your current plan rating is below 3 stars.

If you’re enrolled in a Medicare Advantage or Part D plan that’s been rated under 3 stars for three years in a row, you can use a disenrollment SEP to switch to a better-rated plan (3 stars or higher) or to a new, unrated plan. This option is available once per calendar year from Jan. 1 to Dec. 31.2

To enroll in a five-star Medicare plan or make a plan switch, you have a few choices:

  • Online enrollment: Visit Medicare.gov to compare plans and become a member online.
  • Phone enrollment: Call Medicare at 1-800-MEDICARE (1-800-633-4227) to speak to a CMS member who can help you join.
  • Support: Talk to a licensed insurance advisor. They can help you sign up.

Important note: If you move from a Medicare Advantage plan that includes drug coverage to a 5-star plan that doesn’t, you may lose your Part D coverage. In that case, you may need to wait until the next Open Enrollment Period to re-join, and you might face a late enrollment penalty.

Is a five-star plan always the best? Medicare plan considerations

You should think carefully about your health needs, money, and personal preferences before joining a five-star Medicare plan.

Some things you should think about before enrolling include the following:

  • Are your preferred doctors, specialists and health care clinics under the plan you’re considering?
  • Are there other care team choices within the plan’s network nearby?
  • Does the five-star plan you’re reviewing cover your current medicines? If so, at what tier? Are there limits?
  • What is your out-of-pocket cost going to be?
  • What is your monthly premium, or money you pay each month?
  • What is the cost-sharing model?

Sometimes, choosing a plan that lets you keep seeing your usual doctors and getting good care might mean picking a plan with a slightly lower rating instead of a five-star plan. This swap could also result in potentially lower out-of-pocket health care costs for you, which may be the right move to protect your financial health.

Conclusion

By understanding what a five-star rating means, you can confidently select a plan that ensures high-quality care and excellent customer service.

Disclaimer

For full information, visit www.medicare.gov or call 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week.

References

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