You may still have questions about Medicare Star Ratings and why they are important.

What are Medicare Star Ratings?

The Centers for Medicare and Medicaid Services (CMS) developed the Five Star Quality Rating System to help people measure the experiences of people on Medicare Advantage plans.

What is the range of ratings?

CMS rates Medicare Advantage plans on a scale of one to five. Plans rated as a “5” are the highest rated plans.

Who can enroll in these plans?

Most people who are eligible for Medicare can enroll in 5-Star Medicare plans once outside of the Medicare Annual Enrollment Period (AEP) from December 8 – November 30.

I thought that if you were on Medicare, you could only switch Medicare plans during AEP. Can I switch to a 5-Star Medicare plan after AEP is over?

Yes, most people with Medicare can enroll in a plan that has a rating of five stars outside of the normal AEP period even if they are already on Medicare. People cannot switch to a plan that has fewer than five stars outside of the normal AEP period.

How do plans achieve 5-Star status?

1. Staying healthy: Screenings, tests and vaccines

2. Managing chronic (long term) conditions, such as: Diabetes, heart disease and respiratory illnesses

3. Member experience with the health plan

4. Health Plan customer service

5. Member complaints and changes in the health plan’s performance

How many plans have a 5-Star rating?

Out of 600+ Medicare Advantage plans in the country, only 23 received a rating of five stars.

How do I know how many stars a plan received?

You can learn about a plan’s rating online on the Medicare.gov plan finder, or you can ask the health plan or a licensed Medicare agent directly.

What do the Star Ratings have to do with the care that I get from my health care providers?

In order for a Medicare plan to receive a higher rating, the health care provider must make sure that the plan members–their patients — receive quality preventive care. This includes keeping you up-to-date on your preventive screenings, tests and vaccines. They must show that they are adequately helping their patients with chronic conditions such as diabetes, heart disease and respiratory illnesses, and that they are helping them get healthier by managing their conditions and symptoms.

How can I learn more?

To learn more about Wellmed, attend one of our local events hosted by our WellMed doctors who specialize in helping people feel their best. Visit WellMed (Opens in new window) or USMD (Opens in new window) to learn more.